THE  UNIVERSITY 
OF  ILLINOIS 
LIBRARY* 


From  the  collection  of 
Julius  Doerner'i  'Chih^o 


Return  this  book  on  or  before  the 
Latest  Date  stamped  below. 


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THE 


HANDBOOK  FOR  MOTHERS; 

A GUIDE  IN  THE 

CARE  OF  YOUNG  CHILDREN. 


BY 

EDWARD  H.  PARKER,  M.D. 

LITE  PRESIDENT  OF  THE  MEDICAL  SOCIETY  OF  THE  STATE  OF  NEW  YORK  j FORMERLY 
PROFESSOR  OF  ANATOMY  AND  PHYSIOLOGY  IN  THE  NEW  YORK  MEDICAL 
COLLEGE  ; FORMERLY  PHYSICIAN  TO  THE  CHILDREN’S  DEPART- 
MENT OF  THE  DEMILT  DISPENSARY,  ETC.,  ETC. 


NEW  YORK: 

PUBLISHED  BY  HURD  AND  HOUGHTON, 

459  Broome  Street. 

1867. 


Entered  according  to  Act  of  Congress,  in  the  year  1857,  by 
EDWAKD  P.  ALLEN, 

In  the  Clerk’s  Office  of  the  District  Court  of  the  Southern  District  of  New  York. 


I 


PREFACE  TO  THE  SECOND  EDITION. 

in  presenting  this  second  edition  of  the  Handbook 
for  Mothers,  it  is  proper  to  say  that  it  is  done  in  accord- 
ance with  the  repeated  and  urgent  requests  of  friends 
and  strangers,  both  in  and  out  of  the  medical  profes- 
sion, and  from  all  parts  of  the  country.  The  author  is 
deeply  sensible  of,  and  grateful  for,  the  uniformly  kind 
reception  given  to  the  first  edition  by  his  professional 
brethren,  as  well  as  the  public  generally,  and  trusts 
that  this  will  be  received  with  equal  favor.  But  slight 
alterations  have  been  made  in  the  text,  and  these  are 
mostly  of  a verbal  character. 

Poughkeepsie,  N.  Y. 


PREFACE. 


A book  which  could  be  placed  in  the  hands  of 
mothers,  and  be  to  them  a safe  and  sufficient  guide 
in  the  management  of  their  children,  has  often  been 
sought  by  me.  Those  which  are  to  be  found,  seem 
to  me  faulty,  by  including  too  much  on  some  topics, 
while  on  others  they  are  deficient.  I doubt  the 
policy  of  placing  full  and  technical  descriptions  of 
all  varieties  of  disease  in  the  hands  of  mothers. 
Their  anxieties,  which  are  at  the  best  great,  are 
increased  by  the  array  of  half-understood  technical- 
ities. By  morbidly  dwelling  upon  symptoms  as 
described  in  books,  each  movement  of  the  child 
becomes  a source  of  alarm.  Water  on  the  brain,  or 
other  terrible  disease,  is  constantly  apprehended,  and 
the  mother  not  only  suffers  herself,  but  is  tempted  to 
injure  her  child  by  unnecessary  dosing.  My  inten- 


vi 


PREFACE. 


tion  has  been  to  avoid  these  errors,  and  to  give  to 
the  mother  just  that  information  which  she  needs 
as  a mother,  and  not  that  which  will  make  her 
believe  that  she  can  do  without  the  services  of  a 
physician  when  her  child  is  sick.  A smattering  of 
medical  knowledge,  is  an  especially  dangerous  thing. 
If  the  directions  which  I have  given  as  to  the  care 
of  the  child  in  health,  seem  to  be  occasionally  too 
particular  and  full,  when  it  was  not  necessary,  I 
can  only  say  that  these  are  just  the  points  upon 
which  mothers  have  frequently  asked  for  instruction, 
and  for  which  they  have  been  especially  grateful. 
I have  had  repeated  occasion  to  dwell  upon  all  these 
topics  in  conversation  with  mothers,  and  should  have 
been  glad  of  just  this  book  to  place  in  their  hands. 

New  York,  279  Fourth  Avenue. 


CONTENTS. 


Page 

Chapter. 

I.  -On  the  Care  of  the  Child  before  its  Birth,  11 

IX  __On  the  Birth  of  the  Child,  ....  22 

III.— Concerning  the  First  Month,  . . • • 31 

Of  Nursing  ; of  Sleeping  ; of  Bathing  ; Dress  ; of  Exposure  to 
the  Fresh  Air. 


IV —Of  Wet  Nurses,  . 

y. — Of  Artificial  Feeding, 

VI.  Of  the  Second  Six  Months,  ...» 

Of  the  Dress  of  the  Child  from  the  Sixth  to  tbe  Twelfth 
Month  ; Of  the  Diet,  Exercise  and  Habits  of  the  Child 
during  the  Second  Six  Months. 

VII. — The  Second  Year, 

Of  Weaning  ; Rules  concerning  Weaning  ; Manner 

Vug;  the  Dress;  the  Bed,  Ventilation  of  the  Sleeping 
Room  ; of  Education  ; of  Creeping  and  Walking. 

VIII.  From  the  Second  to  the  Sixth  Year, 

Of  the  Teeth  ; Diet ; the  Toilet ; the  Dress  ; Education. 


56 

64 

79 


98 


118 


IX.— Of  Sick  Children, 

Of  the  general  signs  of  Disease. 


129 


r 


yiii 


CONTENTS. 


X.  — Of  Particular  Symptoms, 

Of  Constipation,  Diarrhoea,  &c.  ; of  Coughs. 

XI.  The  Management  of  the  Sick  Room, 

XII.  — Of  Emergencies,  ... 

0f  Ea^lS“rSjl^0king:^U,)StanCe3  ln  thc  Nose  «1 

’ B^s  and  Scalds  ; Wounds,  Sprains,  Bruises  and 
Poisons  B°neS  ’ BleedinS  from  the  Nose  ; Earache  ; 


147 

177 

198 


Appendix. — Dietary, 


WineWhey-MilkPunch;  Beef  Tea;  Beef  Soup;  Chicken 
Rrnfi^  Esse°c®  5 Stewed  Oysters  ; Beef  Steak ; 

Broiled  Chicken  ; Boiled  Rice  ; Fried  Rice  ; Sweet  Pota- 
*?es  i -Arrowroot » Corn  Starch  ; Sago  ; Wheat  Gruel  • 
Toast  Water;  Lait  de  Poule;  Isinglass  Jelly;  Tapioca 


236 


aNDEX, 


. 243 


THE 


HANDBOOK  FOR  MOTHERS. 


Chapter  I. 

ON  THE  CARE  OP  THE  CHILD  BEFORE  ITS  BIRTH. 

The  mother’s  care  of  her  child  should  commence 
with  its  very  conception,  and  continue  till  it  goes 
out  to  take  its  share  in  the  responsibilities  of  life. 
Too  many  are  either  ignorant  of  this,  or  neglect  to 
consider  the  child’s  welfare,  till  it  commences  its  sep- 
arate existence  at  birth ; and  yet,  the  popular  belief 
in  marks  evinces  a general  opinion  that  the  mother 
may  influence  her  child,  physically,  while  it  is  yet 
unborn.  It  is  not  decided  to  the  satisfaction  of  the 
medical  profession,  whether  or  not  objects  producing 
great  mental  impressions  on  the  pregnant  woman,  may 
leave  their  traces  in  spots  on,  or  deformities  of,  her 
child.  Many  facts  of  interest  have  been  collected — 


12 


CARE  OF  THE  CHILD 


Mother's  marks.  Avoiding  surprises  and  shocks.  Effect  of  anxiety. 

some  of  which  support  one,  and  some  the  other  view 
of  the  question.  The  mother’s  duty  is,  therefore,  evi- 
dently  this  : to  avoid,  while  enceinte , all  situations  in 
which  she  may  expect  to  be  exposed  to  meet  sudden 
and  disagreeable  surprises ; to  avoid  the  sight  of 
every  strange  animal  or  deformed  person  so  far  as 
is  practicable  • and  if  such  sights  or  surprises  are 
encountered,  not  to  allow  her  mind  to  dwell  upon 
them  for  a moment.  That  all  the  “ strawberry  ” or 
“ cherry  marks,”  or  “ claret  stains,”  or  other  discolor- 
ations of  the  skin,  are  the  result  of  longings,  there 
is  little  reason  to  believe  — if,  indeed,  any  can  justly 
be  entitled  to  consideration.  The  instances  of  phys- 
ical marking  are  the  exceptions.  If,  then,  any  one  who 
reads  this  fears  she  has  marked  her  unborn  offspring, 
let  her  at  once  lay  aside  every  thought  of  it.  The 
possibility  of  it  is  very  slight,  and  to  indulge  in  anx- 
iety about  it,  if  it  has  any  influence  in  this  respect, 
is  to  produce  the  dreaded  result — while  the  possi- 
bility of  injury  in  other  ways,  from  excessive  anxiety, 
is  not  only  possible,  but  probable. 

I have  said,  however,  that  the  mother  should  care 
for  her  child  long  before  its  birth.  Although  it  may 
not  be  true  that  children  are  marked,  it  is  undenia- 
bly so  that  the  child’s  physical,  mental,  or  moral 


BEFORE  ITS  BIRTH. 


13 


The  child’s  constitution  depends  on  its  mother.  A healthy  mind  and  body. 

constitution  may  be  permanently  affected  by  the 
mother.  The  sickly,  feeble  mother  rarely  has  a 
robust  and  healthy  child.  The  mother  of  small 
mental  abilities  does  not  often  bear  an  intellectual 
giant,  nor  does  she  who  gives  way  to  every  impulse 
and  passion,  find  in  her  offspring  that  gentleness 
and  equability  of  temper  in  which  she  is  deficient. 
These  are  the  extremes;  but  within  these  limits 
the  same  rule  holds  true.  To  adduce  authorities  in 
support  of  these  statements  is  not  now  my  purpose, 
but  rather  to  insist  upon  the  practical  deductions 
from  them. 

As  soon  as  a woman  knows,  or  even  suspects,  that 
she  is  about  to  become  a mother,  she  should  do  eve- 
rything in  her  power  to  give  to  her  child  a healthy 
mind  in  a healthy  body.  Not  that  she  should  indulge 
in  such  excessive  anxiety  upon  the  subject  as  to 
destroy  her  peace  of  mind — for  that  would  defeat 
the  very  purpose  which  is  aimed  at — but  that  she 
should  take  that  reasonable  and  intelligent  care  of 
her  child,  which  shall,  so  far  as  she  is  concerned, 
permit  it  to  cast  no  reproaches  on  its  parents. 

During  the  period  of  life  within  the  womb,  the 
child  receives  all  its  nourishment  from  the  blood  of 
the  mother.  By  an  arrangement  most  exquisite  in 


14 


V 

' 

CARE  OP  THE  CHILD 
How  the  child  is  nourished.  The  mother’s  diet.  Erroneous  idea. 

its  adaptation  to  the  purpose  to  be  accomplished,  the 
blood  of  the  mother  is  brought  into  almost  immediate 
contact  with  that  of  the  child,  a delicate  membrane 
alone  intervening,  and  through  it  those  elements 
of  the  child’s  blood  which  are  injurious  to  it  are 
removed,  while  the  elements  of  the  child’s  growth 
are  at  the  same  time  taken  into  its  circulation.  If 
then  the  blood  of  the  mother  is  not  fitted  to  nourish 
her  own  body,  it  cannot  give  to  the  child,  in  abun- 
dance, those  nutrient  materials  the  best  fitted  to  build 
up  for  it  a vigorous  constitution.  If  her  blood  is  not 
purified  from  those  elements  which  are  injurious,  (as 
the  gases  which  should  be  thrown  off  by  the  lungs,) 
the  blood  of  the  child  cannot  be  purified  to  that 
degree  which  its  well-being  demands. 

For  these  reasons,  she  who  is  about  to  be  a mother 
should  at  once  pay  especial  attention  to  her  general 
health.  Her  diet  should  be  simple  and  nourishing, 
not  selected  from  spiced  food,  nor  with  an  excess  of 
stimulants,  either  solid  or  fluid. 

There  is  an  idea,  not  very  uncommonly  entertained, 
that  if  the  mother  limits  herself  very  closely  to  just 
as  little  food  as  will  barely  enable  her  to  avoid 
suffering  from  hunger — that  is,  if  she  almost  starves 
herself — her  child  will  be  smaller,  and  she  will  there- 


BEFORE  ITS  BIRTH. 


15 


The  most  desirable  condition. 

fore  suffer  less  at  the  time  of  its  birth.  If  such  a 
course  has  such  an  effect,  it  must  be  by  interfering 
with  the  development  of  the  child,  and  thus  giving 
the  mother  a sickly  infant,  in  place  of  one  that  is 
healthy.  No  intelligent,  reasonable  woman  can,  it 
seems  to  me,  thus  deliberately  entail  upon  her  child  a 
life  of  ill-health,  that  she  may  avoid  a few  moments 
suffering,  for  the  difference  that  is  thus  produced  in 
the  pains  is  almost  inappreciable. 

In  the  most  desirable,  the  most  perfect  condition  of 
the  mother,  she  finds  herself  with  an  appetite  which 
is  greater  than  ordinary,  but  which  is  satisfied  with 
simple  meats,  fruits,  and  vegetables,  with  no  sensation 
but  that  of  perfect  health,  and  except  from  her 
increasing  size,  with  no  intimation  of  the  new  life 
developing  itself  within,  till  her  child  commences  its 
movements,  or  as  it  is  commonly  called,  till  quicken- 
ing occurs.  To  this  condition  every  mother  should 
endeavor  to  attain.  For  this  purpose  care  should  be 
taken  that  the  bowels  are  moved  once  every  day,  for 
when  constipation  occurs  at  this  time  it  brings  with 
it  many  discomforts  and  annoyances.  The  appetite 
even  may  fail,  and  both  mother  and  child  suffer 
in  consequence.  When  constipation  does  occur,  if 
slight,  the  more  abundant  use  of  fruit,  the  selection 


16 


CARE  OF  THE  CHILD 


Constipation.  Injections.  Prescription 

of  coarser  food, — as  cracked  wheat  or  corn, — will 
frequently  entirely  remove  the  sluggishness  of  the 
bowels ; but  if  this  does  not  suffice,  recourse  must  be 
had  to  some  of  the  following  modes  of  treatment. 
Simple  water  injections,  neither  very  warm  nor  very 
cold,  are  good  for  those  who  are  accustomed  to  them,  or 
can,  with  convenience,  use  them.  Several  kinds  of 
apparatus  are  now  sold,  which  allow  any  desired 
quantity  of  fluid  to  be  thrown  into  the  bowels  without 
the  annoyance  of  removing  for  refilling,  and  with 
these,  an  injection  becomes  almost  a luxury.  When 
depended  upon,  the  injection  requires  to  be  used  at 
the  same  time  of  day,  that  the  tendency  may  be  to 
create  in  the  bowels  such  a habit  of  moving  that  it 
may  be  dispensed  with.  Not  more  than  a pint  of 
fluid  should  be  used,  and  it  is  not  well  to  add  any- 
thing to  the  water,  as  there  is  some  danger,  if  that  is 
done,  that  a miscarriage  will  be  produced.  If  these 
methods  do  not  answer  the  purpose,  pills  may  be 
used,  made  of  these  ingredients:  — 

Take  of  powdered  rhubarb,  - - one  drachm. 

“ “ “ jalap,  - - - one  “ 

“ “ u myrrh,  - - one  “ 

“ “ castile  soap,  - - one-half  “ 

Mix  and  make  sixty  pills. 


\ 


BEFORE  ITS  BIRTH. 


17 


Acidity  of  the  stomach.  Taking  medicine.  Halit. 

Should  there  be  excessive  acidity  of  the  stomach, 
an  equal  quantity  of  bicarbonate  of  soda  may  be  sub- 
stituted for  the  myrrh. 

Of  these,  if  the  constipation  is  very  great,  two  may 
be  taken  every  morning,  and  two  every  night,  until 
the  bowels  move  more  freely,  when  one  may  be  taken 
every  morning  and  night,  or  what  is  better  still,  two 
at  night,  those  for  the  morning  being  omitted.  • If 
these  are  found  to  answer  the  purpose  too  fully,  one 
may  be  omitted, — and  the  other  as  soon  as  it  is  not 
needed.  It  is  always  to  be  borne  in  mind,  that  tak- 
ing medicine  is  an  evil,  to  be  resorted  to  only  to 
avoid  a greater  evil,  and,  therefore,  it  is  to  be  omitted 
as  soon  as  the  occasion  which  called  for  it  has  passed 
away.  Fruits  and  coarse  food  should  continue  to  be 
used  while  the  tendency  to  constipation  lasts,  and  if 
they  answer  the  purpose  sufficiently,  it  is  vastly  better 
than  a resort  to  medicines.  It  should  also  be  remem- 
bered, that  habit  accomplishes  very  much  in  this 
respect,  and  a certain  hour  being  devoted  regularly 
to  expecting  an  evacuation,  is  very  apt  to  assist  in 
the  uniform  performance  of  this  function.  Should 
these  methods  alone,  or  in  combination,  fail  to  afford 
relief,  the  medical  adviser  should  be  at  once  con- 
sulted, for  the  habit  should  not  be  allowed  to  continue, 
2 


18 


CARE  OP  THE  CHILD 


Diarrhoea.  Its  treatment 

— and  tlie  use  of  more  potent  remedies,  requires  the 
constant  superintendence  of  a physician. 

Sometimes  from  imprudence  in  diet,  a sudden  chill, 
or  some  other  cause,  the  opposite  condition — namely, 
that  of  diarrhoea — is  produced,  and  demands  imme- 
diate attention.  Its  continuance  is  full  of  risk  to  the 
unborn  child.  When  it  occurs,  the  mother  should  at 
once  lie  down  (and  it  is  better,  from  the  anatomical 
arrangement  of  the  large  intestine,  to  lie  upon  her 
right  side),  and  remain  in  that  position.  The  effort 
to  “ keep  about,”  which  it  is  the  temptation  to  make, 
is  only  a waste  of  time.  Abstinence  from  food  and 
drink  for  a few  hours  will  do  much,  with  position,  to 
remove  the  difficulty.  Cold  water,  especially,  should 
be  avoided — a pretty  strong  tea,  either  green  or 
black,  being  far  preferable.  Toasted  bread,  rice, 
crackers,  &c.,  are  the  best  food,  while  a half  tea- 
spoonful  of  paregoric,  or  from  five  to  ten  drops  of 
laudanum  may  be  taken  on  a little  sugar  every  two 
or  three  hours.  If  the  attack  is  anything  more  than 
very  slight,,  a physician  should  be  called.  I scarcely 
need  to  say  that  it  is  a suggestion  of  ordinary  pru- 
dence, to  avoid  what  has  once  caused,  or  been  even 
suspected  of  producing  diarrhoea.  For  those  who 
are  distant  from  a physician — as  is  the  case  with 


BEFORE  ITS  BIRTH . 


19 


Prescription.  Indigestion.  2 he  urine. 

many  on  the  plantations  of  the  South,  or  the  scat- 
tered farms  of  the  North — it  may  be  well  to  have 
this  mixture  constantly  by  them  : — 

Take  of  tincture  of  opium,  - two  teaspoonfuls. 

“ “ tincture  of  red  pepper,  one  “ 

“ “ tincture  of  camphor,  one  u 

“ “ comp,  spirits  of  lavender,  four  “ 

The  dose  of  this  is  fifteen  or  twenty  drops,  to  be 
repeated  every  two  hours  if  necessary.  It  should  be 
lessened  as  the  disease  abates,  till  six  drops  only  are 
taken.  Or  a very  small  injection  (not  more  than  one 
or  two  tablespoonfuls)  of  a thick  solution  of  starch, 
containing  thirty  or  forty  drops  of  laudanum,  may 
be  used  ; and,  if  necessary,  may  be  repeated  in  three 
hours,  provided  there  is  no  great  drowsiness  produced 
by  it. 

It  is  important,  in  the  first  months  of  pregnancy 
especially,  that  the  mane  should  not  be  allowed  to 
accumulate  in  the  bladder  so  as  to  distend  it  exces- 
sively. Particular  care  must  be  taken  to  avoid  this  in 
journeying,  or  serious  results  may  follow.  This  is  a 
consideration  of  peculiar  importance  to  the  mother, 
but  is  not  without  it  for  the  child.  It  does  not  require 
to  be  dwelt  upon. 

From  the  fact  that  a very  considerable  portion  of 


20 


CARE  OF  THE  CHILD 


Bathing.  Exercise.  Dancing. 

the  substances,  which  arise  from  the  wearing  out  of  the 
tissues,  is  thrown  off  by  the  skin,  bathing  is  at  all 
times  of  hygienic  value.  The  substances  poured  out 
upon  the  skin  by  the  perspiration,  whether  sensible 
or  insensible,  should  be  removed  frequently  ; requir- 
ing not  simply  a washing  of  the  hands  and  face,  but 
of  the  whole  body.  Its  value  increases  at  this  period, 
and  should  be  conscientiously  attended  to. 

Exercise  should  be  regular  and  gentle ; if  there  is 
any  known  tendency  to  miscarriage,  it  should  be  very 
gentle.  It  should  be  in  the  open  air  as  much  as  pos- 
sible ; walking  in  moderation,  and  riding  in  easy 
carriages  are  the  best  modes  of  enjoying  it.  Exces- 
sive fatigue,  from  any  cause,  should  be  scrupulously 
avoided,  as  well  as  jumping  from  a carriage,  and  all 
such  jars  as  from  horseback  riding.  Dancing,  if  vio- 
lent, is  injurious  ; if  in  heated  rooms,  and  protracted 
to  late  hours,  it  is  equally  bad ; but  as  the  gentle  and 
moderate  recreation  which  it  should  be,  it  is  harm- 
less. The  greatest  care  should  be  taken  to  avoid 
lifting  heavy  objects,  from  making  great  efforts  to 
reach  things  not  easily  accessible — as  those  upon 
upper  shelves,  beyond  easy  access — and,  in  short,  to 
avoid  whatever  may  tend  to  produce  any  strain. 

The  same  rule  of  constant  moderation  should  be 


* 


BEFORE  ITS  BIRTH.  21 

Mental  fatigue.  The  emotions.  Summary. 

observed  in  the  operations  of  the  mind.  Excessive 
mental  fatigue,  whether  from  intellectual  labor  or 
from  excitements,  must  be  shunned.  For  this  reason, 
it  is  sometimes  necessary  to  lay  aside  for  a time,  the 
use  of  coffee  — which  is  an  active  stimulant  of  the 
brain,  leaving,  after  its  effects  have  passed  away,  a 
proportional  exhaustion.  Moral  emotions,  as  joy 
and  grief,  should  also  be  kept  within  moderate 
bounds  ; and  if  these,  much  more  those  which,  when 
stronger,  are  more  violent — as  anger,  jealousy,  and 
hate. 

The  brief  summing  up  of  the  mother’s  duties  dur- 
ing this  period,  is  this  : — That  she  should  strive  to 
give  every  perfection  to  the  physical  development  of 
her  child,  by  carefully  attending  to  her  own  physical 
condition  ; and  that,  by  the  preservation  of  that  uni- 
form and  equable  temperament,  both  mental  and 
moral,  which  finds  its  most  perfect  development  in 
woman,  she  should,  as  far  as  possible,  give  her 
child  this  same  precious  inheritance,  assured,  as  she 
may  be,  that  the  practice  of  this  discipline  and 
restraint  will  be  richly  repaid  to  her  by  the  greater 
ease  with  which  she  will  meet  the  constant  trials 
which  a mother  endures,  in  the  cares  devolving  upon 
her  on  the  birth  of  her  dearest  infant. 


22  ON  THE  BIRTH  OF  THE  CHILD. 


Child-bearing  not  sickness. 


Chapter  II. 

ON  THE  BIRTH  OF  THE  CHILD. 

At  the  time  of  confinement  there  is  but  little  to  be 
done  on  the  part  of  the  mother,  for  the  benefit  of  the 
child.  Her  sufferings  are  sufficient,  one  would  sup- 
pose, to  occupy  her  every  thought ; and  yet  I have 
frequently  seen  a woman  far  more  anxious  to  know 
that  her  child  is  safe,  than  that  her  pains  are  ended. 
The  mother  should  remember  that  the  birth  of  a 
child  is  a strictly  natural  function,  one  which  is  a 
healthy  process,  and  not  to  be  confounded  with  sick- 
ness, which  it  is  so  frequently  called.  It  is  a period 
of  peculiar  exposure  to  disease  and  injury,  and  I 
cannot  conceive  of  an  intelligent  woman  approach- 
ing it,  without  much  grave  thought,  and  something  of 
that  putting  of  her  house  in  order  which  danger 
suggests.  But  she  should  remember  that  the  vast 


ON  THE  BIRTH  OF  THE  CHILD.  23 


Encouragements.  Ether  and  chloroform. 

majority  of  her  sex  pass  through  these  perils  entirely 
unscathed,  and  that  the  best  preventive  of  danger 
is,  after  having  taken  every  precaution  against  it  of 
which  she  is  informed,  to  think  no  more  of  it,  but  to 
trust  all  to  the  great  Disposer  of  events.  If  she  has 
successfully  followed  the  directions  of  the  preceding 
chapter,  she  must  be  prepared  completely  for  this 
period, — herself  healthy,  her  child  healthy,  she  has 
made  every  physiological  preparation  for  the  perfec- 
tion of  this  physiological  process.  The  expulsion  of 
the  child  from  the  womb  is  simply  mechanical,  requir- 
ing in  the  vast  majority  of  cases  no  interference.  It 
is  attended  with  more  or  less  pain  to  the  mother,  this 
being  Eve’s  legacy  to  her  sex,  but  the  pain  is  rarely 
if  ever  an  indication  of  danger.  Ether  and  chloro- 
form now  remove  even  this  without  interfering  with 
the  perfection  of  the  function.  Knowing  these  things, 
the  mother  should  enter  upon  her  confinement  with- 
out anxiety,  and  endure  her  pain  with  that  fortitude 
which  is  a characteristic  of  woman,  leaving  the  care 
of  herself  and  her  child  to  her  attendants. 

It  is  for  these  reasons  that  the  selection  of  the 
nurse  and  the  physician,  should  be  made  with  care 
and  deliberation.  To  leave  either  to  the  last  moment 
is  unwise,  as  it  is  unsafe.  The  perfection  of  a nurse 


24 


ON  THE  BIRTH  OF  THE  CHILD. 


Selection  of  the  nurse.  a good  nurse. 


The  physician 


is  found  in  an  intelligent  woman ; not  so  conceited 
as  to  be  unwilling  to  be  taught,  nor  so  opinionated 
as  to  insist  upon  having  her  own  way,  regardless  of 
the  wishes  of  the  patient,  or  the  directions  of  the 
physician ; who  is  patient  and  gentle,  forgetting  her 
own  ease  when  the  comfort  and  well-being  of  her 
patient  requires  it;  not  too  talkative,  and  yet  not 
morosely  silent ; not  above  doing  whatever  necessity 
demands ; scrupulously  neat,  prudent,  thoughtful,  con- 
siderate,, and  kind.  Such  persons  cannot  be  often 
found  serving  in  this  capacity,  but  the  nearer  the 
approach  to  it  the  better  the  nurse.  Six  weeks  care 
by  such  a person,  will  do  wonders  for  the  mother  and 
the  child,  and  money  expended  for  her  wages,  will  be 
largely  returned  in  their  increased  health  and  com- 
fort. The  nurse  should  be  engaged  for,  and  be 
present  at,  the  time  of  confinement. 

The  physician  should  be  a gentleman, — not  in 
manner  only,  but  in  feeling  ; of  high  moral  and 
intellectual  qualifications  j attentive,  sympathizing, 
calm  amid  dangers,  with  a wise  head,  a brave  heart, 
and  a skilful  hand.  Age  does  not,  of  necessity,  bring 
any  of  these  virtues,  and  a young  man  who  possesses 
these  qualifications,  should  be  preferred  to  one  who 
is  destitute  of  them,  or,  if  he  be  not  fully  occupied,  to 


ON  THE  BIRTH  OF  THE  CHILD. 


25 


, An  emergency, 

lemale  practitioners. 

his  equally  able  elder  who  is  crowded  with  occupa- 
tion. He  should  be  personally  agreeable  to  the 
patient,  and  one  to  whom  she  can  trust  herself  with 
perfect  confidence.  Either  of  these  conditions  being 
uncomplied  with,  may  protract  the  labor  for  hours. 
A great  and  constant  doser  is  to  be  avoided,  as  is 
also  the  timid  and  vaccillating.  It  is  wise  for  the 
patient  to  see  the  physician  two  or  three  times  before 
her  confinement,  that  there  may  be  no  feeling  as  of 
a stranger’s  presence,  but  that  he  may  be  welcomed 
as  a friend,  whose  very  presence  soothes* 

There  is  but  one  emergency  which  is  likely  to 
arise,  of  which  it  is  necessary  for  me  to  speak. 
Although  the  mother  is  not  often  able  to  give  direc- 
tions concerning  it,  she  sometimes  is  compelled  to  do 
so,  or  allow  her  child  to  die  in  the  moment  of 
its  birth.  I refer  to  the  birth  of  the  child  in  the 
absence  of  the  physician.  If  this  occurs— and  it 
sometimes  will  in  spite  of  every  precaution,— the 
child  should  be  allowed  to  remain  upon  the  bed,  pro- 
tected from  the  cold,  with  access  of  the  air  to  the 


* As  to  female  practitioners,  I would  gladly  recommend  them,  could  I do  so  con- 
scientiously, but  they  are  usually  very  imperfectly  educated,  and  I would  no  more 
trust  to  them  than  to  a student  just  commencing  medicine.  When  this  defect  does 
not  exist,  the  instances  of  which  are  very  few,  there  is  the  objection  that  woman  has 
not  the  mental  and  physical  powers  which  may  be  demanded, -no  one  can  say 
when.  No  doubt,  however,  some  women  are  to  be  preferred  to  some  men. 


26  ON  THE  BIRTH  OP  THE  CHILD. 

acM.  Bow  to  lie  the  m-d. 

mouth,  that  it  may  be  able  to  breathe.  The  nurse 
should  pinch  the  cord  which  goes  from  the  child’s 
navel  tightly  between  her  thumb  and  fingers,  so  as  to 
stop  the  beating  in  the  arteries  of  the  cord  beyond 
her  fingers.  She  may  take  hold  of  the  cord  for  this 
purpose  about  six  inches  from  the  child’s  body.  If 
the  physician  is  expected  to  arrive  soon,  and  there  is 
no  flowing  from  the  mother,  or  severe  fainting,  she 
should  continue  thus  to  hold  the  cord  till  he  comes. 
If  he  cannot  be  present  for  some  time,  she  may  tie  the 
cord,  proceeding  in  this  way : take  a strong  string  (a 
piece  of  stout  sadlers’  silk  is  preferred  by  me),  twelve 
or  fifteen  inches  long,  and  put  it  round  the  cord  once, 
tying  it  in  the  usual  way  of  a single  knot.  It  should 
be  about  two  inches  from  the  child’s  body.  Then  it 
should  be  drawn  tight,  so  as  entirely  to  stop  all  beating 
beyond  it,  the  precaution  being  taken  not  to  let  either 
hand  slip,  for  fear  the  cord  should  be  torn  away 
from  the  body  of  the  child,  which  is  a very  grave 
accident.  This  may  be  avoided  by  taking  the  string 
between  the  thumb  and  forefinger  of  each  hand, 
allowing  it  to  pass  across  the  inside  of  the  others 
and  over  the  little  fingers.  The  thumbs  should  now 
be  pressed  together  and  the  string  drawn  tight  by 
separating  the  little  fingers.  The  hands  will  thus 


ON  THE  BIRTH  OF  THE  CHILD.  27 

Cutting  the  card . How  10  d^ard  against  its  Heeding 

roll  on  each  other,  but  will  not  be  likely  to  slip 
away  from  their  position.  The  knot  is  secured  by 
another  tie,  that  is,  it  is  made  a hard  knot.  The 
ends  should  not  be  cut  off  yet.  Another  similar 
string  must  now  be  tied  round  the  cord  about  two 
inches  farther  from  the  child  than  the  first  one  : and 
then,  with  a sharp  pair  of  scissors,  the  cord  may  be 
cut  in  two.  All  this  should  be  done  in  a good  light, 
and  especial  care  should  be  taken  that  a toe  or  fin- 
ger is  not  included  in  either  string,  or  much  more, 
that  nothing  is  in  the  way  of  the  scissors  so  as  to  be 
injured  by  them.  After  the  cord  is  divided,  the  cut 
end  next  the  child,  should  be  wiped  clear  of  blood, 
and  then  carefully  examined  to  be  sure  there  is  no 
bleeding  from  it.  If  it  does  bleed,  the  cord  must  be 
again  tied  a little  nearer  the  child's  body  than  the  first 
string,  and  with  the  same  precautions  as  before. 
The  cord,  however,  is  not  to  be  again  cut.  When  it 
is  ascertained  that  there  is  no  bleeding  from  the 
cord,  the  ends  of  the  string  may  be  cut  off  within  an 
inch  of  the  knot,  and  the  child  may  be  carefully 
wrapped  in  a warm  and  soft  blanket  or  sheet,  and 
kept  from  all  exposure  to  the  cold,  it  being  allowed 
air  enough  to  breathe. 

Sometimes  it  happens  that  the  child  does  not 


28  ON  THE  BIRTH  OF  THE  CHILD. 


How  to  make  the  child  breathe.  Wftai  fo  do  if  ^ 

breathe  when  it  is  first  born.  This  should  be  thought 
of;  and  if  it  is  found  to  be  the  case,  the  child’s 
naked  chest  should  be  blown  upon,  with  short  but 
rigorous  and  repeated  puffs  from  the  mouth;  its 
chest  may  be  rubbed  smartly  with  the  hand,  or  a 
towel  with  or  without  the  aid  of  spirit;  or  it  may 
be  sprinkled  with  cold  water,  smartly  snapped  with 
the  hand ; or  a little  cold  water  or  spirit  may  be  taken 
into  the  mouth,  and  spirted  upon  the  chest  so  as  to 
strike  it  with  some  force  ; or,  if  these  fail,  the  nurse 
should  put  her  mouth  over  the  mouth  and  nose  of  the 
child  and  blow  up  its  lungs,  at  the  same  time  that 
the  other  means  continue  to  be  used,  "V~6ry  rarely 
will  all  of  these  measures  fail  to  produce  the  desired 
result.  When  breathing  is  fairly  established,  the 
child  should  be  allowed  to  remain  without  separation 
of  the  cord,  till  all  the  purple  color  has  passed  off 
from  the  face,  and  then  the  nurse  may  proceed  as 
before  directed  to  tie  the  cord. 

If  there  is  very  great  bleeding  from  the  mother, 
or  if  she  is  very  faint,  some  one  else  should  be  called 
to  hold  the  cord,  as  before  directed,  while  friction  is 
made  over  the  lower  part  of  the  abdomen  to  stop  the 
flow ; or  cloths  are  applied,  wet  with  cold  water  or 
containing  pieces  of  ice ; while,  at  the  same  time,  the 


ON  THE  BIRTH  OF  THE  CHILD. 


29 


Restoratives,  <£c.  Use  of  ether  and  chloroform 

usual  restoratives  for  fainting  are  resorted  to,  such 
as  spirits  of  hartshorn,  laying  the  patient  flat  on  the 
bed,  and  giving  her  a little  brandy.  If  no  one  else 
is  present,  the  nurse  should  put  on  the  string  as  first 
described,  and  then  attend  to  the  mother,  leaving  the 
application  of  the  second  string,  and  the  cutting  of 
the  cord,  till  the  mother  is  in  a safer  condition.  But 
the  care  of  the  mother  is  incidental  to  the  subject  of 
the  chapter,  and  one  upon  which  its  purpose  does  not 
allow  me  to  dwell. 

It  may  be  a question  for  some,  whether  or  not  they 
can,  so  far  as  the  child’s  welfare  is  concerned,  use 
ether  or  chloroform  at  the  time  of  their  confinement. 
This,  evidently,  is  not  the  place  for  discussing  all  the 
views  which  are  entertained  concerning  the  use  of 
these  agents.  They  are  regarded  very  differently  by 
different  practitioners  ; some  objecting  entirely  to  the 
use  of  either,  some  preferring  one  and  some  the 
other.  Although  I have  had  frequent  occasion  to 
use  both,  I have  yet  to  see  any  injurious  effects 
from  them,  when  given  at  the  time  of  labor.  I pre- 
fer chloroform  when  it  is  pure,  being  very  careful  in 
selecting  that  which  I use.  To  the  mother  the  relief 
from  suffering  which  it  affords  is  immense,  the  recov- 
ery being  often  very  much  hastened  by  it.  To  the 


30  ON  THE  BIRTH  OF  THE  CHILD. 


Effect  of  ancesthdics  on  the  child. 

child  there  is  no  injurious  effect  when  the  labor  is  of 
a natural  length,  and  I have  never  seen  any  harm 
arise  from  using  it  when  the  labor  was  protracted, 
though  it  is  said  to  have  been  witnessed.  I always 
use  chloroform  without  hesitation,  unless  the  patient 
^ objects  to  it,  when  I,  of  course,  do  not  insist  upon  it. 


CONCERNING  THE  FIRST  MONTH.  31 


1 he  mother  to  keep  quiet. 


Chapter  III. 

CONCERNING  THE  FIRST  MONTH. 

The  care  of  the  child  immediately  after  its  birth, 
and  during  the  first  month  of  its  life,  is  a matter  of 
great  importance  to  its  future  well-being.  The 
mother  is  not  often  able  to  attend  to  this  herself,  but 
she  can  usually  see  that  everything  is  done  properly. 
With  a perfect  nurse  no  oversight  would  be  neces- 
sary, and,  in  fact,  the  mother  would  learn  much  from 
her.  But  perfection  is  as  rare  in  this  occupation  as 
in  others,  and  it  is  often  a great  satisfaction  to  the 
mother,  and  a great  advantage  to  the  child,  that 
she  is  able  to  give  directions  concerning  its  care  to 
her  attendant.  As  to  herself,  she  should  not  attempt 
to  do  anything  that  another  can  do  ; rest  and  quiet 
are  of  great  importance  to  restore  her  rapidly,  after 
her  fatigues  and  exhaustion.  It  is  a great  saving  of 


32  CONCERNING  THE  FIRST  MONTH. 


Preparation  for  the  washing.  Use  warm  wat^ 

time  for  her  not  to  hasten  her  getting  up.  Sitting 
up  too  soon — and  it  is  no  matter  if  it  is  not  attempt- 
ed for  a fortnight — frequently  does  injury  which 
involves  years  of  ill-health  and  suffering. 

The  child,  after  the  cord  is  cut,  and  it  has  been 
ascertained  (by  looking  once  or  twice  on  purpose  to 
see)  that  there  is  no  bleeding  from  it,  may  be  laid  in 
a warm  place,  carefully  protected  from  currents  of 
air,  and  covered  with  sufficient  light  but  warm  cloth- 
ing ; and  it  may  be  allowed  to  remain  so  till  the 
mother  has  been  made  comfortable,  and  left  for  a lit- 
tle rest.  During  this  time  it  is,  of  course,  necessary 
that  it  should  be  allowed  to  breathe  fresh  air,  and 
not  be  exposed  to  be  smothered.  When  time  is 
found  in  which  nothing  is  more  imperative,  the  infant 
should  be  washed.  For  this  purpose  a hand-basin  of 
good  size,  or  a very  small  tub,  may  be  used,  and 
about  one-half  filled  with  warm  water.  The  child 
has  just  come  from  the  temperature  of  the  centre  of 
the  mother’s  body,  and  to  put  it  in  water  much  below 
blood  heat  is  to  expose  it  to  a great  shock.  To  use 
cold  water,  as  is  sometimes  done,  is  unjustifiable  ; for 
although  a very  robust  infant  may  not  suffer  from  it. 
the  chances  are,  at  the  best,  that  it  will  take  a vio- 
lent cold.  Too  hot  water  is  also  to  be  avoided. 


CONCERNING  THE  FIRST  MONTH.  33 


How  to  take  up  a new-born  child. 

Very  soft  sponges,  soap,  towels,  and  old,  soft  linen 
should  be  provided  in  abundance,  and  the  clothes 
which  are  to  be  put  on  after  the  washing,  should  be 
conveniently  arranged. 

It  is  sometimes  a problem  how  to  take  up  the  vigor- 
ous child,  covered  as  it  frequently  is  with  a slippery, 
unctuous  matter.  When  this  is  necessary,  the  little 
finger  of  the  right  hand  may  be  put  in  the  armpit  of 
the  child’s  right  side,  and  the  thumb  of  the  same 
hand  in  the  left  armpit,  the  other  fingdrs  reaching  up 
to  support  the  head — the  palm  of  the  hand  support- 
ing the  back — while  the  left  hand  takes  hold  of  both 
feet  firmly,  the  forefinger  passing  between  the  legs 
just  above  the  ankle  bones,  against  which  it  is  firmly 
curled.  It  is  hardly  possible,  when  held  thus,  that 
the  child  should  slip  out  of  the  hands,  and  there  is 
no  danger  of  hurting  it  except  by  grasping  the  feet 
with  too  great  force,  such  as  no  sensible  person 
would  use. 

Everything  being  arranged  conveniently,  the  child 
as  it  lies  in  the  lap,  may  be  first  covered  with  a 
lather  made  in  the  sponge  ; and  this,  after  being 
rubbed  in,  should  be  removed  with  water,  and  the 
surface  wiped  dry  with  the  towel.  The  body  may  be 
washed  first  and  dried ; then  the  legs,  the  arms,  and 
3 


34  CONCERNING  THE  FIRST  MONTH. 


The  first  washing  described.  The  first  dressing. 

the  head  ; each  being  dried  as  soon  as  it  is  clean, 
that  there  may  be  no  exposure  to  cold  from  the  evap- 
orating surface.  If  more  convenient,  the  child  may 
be  put  in  the  water,  though  this  is  not  usually  so  well, 
because  the  soap  soon  makes  the  water  turbid,  and 
the  child’s  body  cannot  be  seen,  when  it  is  impossible 
to  tell  whether  or  not  it  is  clean.  The  difficulty  in 
the  first  washing  is  to  remove  the  cheesy  matter 
on  the  surface.  For  this  purpose  nothing  is  better 
than  soap,  but  it  should  be  a delicate,  not  a coarse 
soap.  The  old  brown  Windsor  is  a favorite,  and 
excellent  variety.  All  of  this  matter  should  be 
carefully  removed,  especial  pains  being  taken  with 
any  creases  that  may  be  found,  and  with  the  hair. 
The  soap  should  be  carefully  kept  from  the  eyes. 
Oil,  lard,  or  egg,  are  frequently  ordered  to  be  applied 
to  the  surface,  before  the  washing,  with  the  notion 
that  they  remove  this  cheesy  matter  more  readily.  I 
have,  however,  never  seen  anything  but  annoyance 
from  them,  and  now  advise  simple  soap.  After  the 
washing  is  completed,  if  the  child  is  cold,  it  had  bet- 
ter be  wrapped  up  snugly  in  a warm  and  very  soft 
blanket,  and  allowed  to  get  warm  before  the  dressing 
is  proceeded  with. 

This  first  dressing  is  a matter  of  some  moment, 


CONCERNING  THE  FIRST  MONTH.  35 


W hat  to  do  to  the  cord. 

and  not  very  easily  accomplished,  unless  one  has 
some  skill  or  tact  in  it.  The  child  is  small,  with- 
out power  to  hold  up  its  head,  or  to  keep  its  back 
stiff,  and  to  fit  its  clothes  about  it  requires  much 
patience  and  dexterity.  The  first  thing  to  be  done 
is  to  dress  the  cord.  The  string  about  it  may  be  cut 
off,  so  that  the  ends  are  only  an  inch  on  each  side 
from  the  knot.  Either  of  these  two  \methods  may 
then  be  followed : First , take  a strip  of  old  and  soft 
linen,  half  an  inch  wide  and  six  inches  long,  and  wind 
it  round  the  cord  as  if  it  were  a finger,  till  it  is  entirely 
covered,  securing  it  with  a piece  of  thread  or  light 
silk.  The  cord  may  then  be  curled  up  on  the  navel, 
and  the  belly-band  applied  over  it.  Or,  second , a 
piece  of  old  linen  three  inches  square  should  be 
taken,  and  two  cuts  made  through  its  centre,  crossing 
each  other  at  right  angles,  and  making  a sufficiently 
large  opening  to  allow  the  cord  to  pass  through ; put 
the  cord  through  it,  double  it  together  so  as  to  include 
the  cord  between  its  sides,  and  wrap  them  round  the 
cord,  securing  them  as  before  with  a thread.  The 
belly-band  goes  over  this.  Nurses  will  frequently 
insist  upon  laying  a “ burnt  rag  ” over  the  cord,  and 
under  the  belly-band.  It  perhaps  does  no  harm,  but 
it  is  filthy  looking,  and  does  no  good.  It  is  as  well 


S6  CONCERNING  THE  FIRST  MONTH. 


The  belly-hand.  The  clothes. 

omitted,  but  if  tbe  nurse  cannot  conquer  ber  preju- 
dices in  its  favor,  it  is  not  worth  while  to  have  any 
contest  about  it. 

The  belly-band  should  be  of  fine  and  soft,  but  firm 
flannel,  about  four  inches  wide  and  about  eighteen 
inches  long.  It  is  better  to  cut  it  straightways  of 
the  cloth,  not  “ bias  n as  has  been  recommended.  If 
this  is  done,  the  pressure  comes  just  where  it  is 
most  needed,  and  the  flannel,  by  use,  stretches  so  as 
to  fit  the  body.  In  dressing  the  child,  the  middle  of 
this  should  be  put  over  the  navel,  one  end  lapped 
over  the  other,  drawn  pretty  firmly,  and  fastened  so 
as  not  to  slip.  There  will  be  less  danger  of  its  slid- 
ing up  on  the  body  of  the  child,  if  the  lower  edge  is 
drawn  a little  tighter  than  the  upper.  The  clothes 
of  the  child  may  now  be  carefully  put  on,  no  violence 
being  used,  either  to  bring  an  arm  into  a convenient 
position,  or  for  any  other  purpose.  Custom,  differing 
in  different  sections,  dictates  what  the  style  of  cloth- 
ing shall  be.  It  is  of  little  importance,  so  long  as  it 
answers  these  conditions,  viz : to  keep  the  child 
warm  enough,  but  not  too  warm ; to  be  light,  and 
nowhere  tight.  It  should  be  borne  in  mind,  however, 
that  the  newborn  infant  requires  to  be  carefully 
guarded  from  the  depressing  influence  of  cold,  and 


CONCERNING  THE  FIRST  MONTH.  37 


Deformities.  First  nursing. 

that  it  feels  this  sooner  than  older  children.  Feeble 
children  should  especially  be  defended  from  it,  and 
whenever  their  feet  are  found  to  be  too  cool,  they 
should  be  thoroughly  warmed.  I do  not  know  of  a 
more  complete  illustration  of  comfort,  than  is  afforded 
by  a young  infant  lying  in  the  nurse’s  lap,  and  enjoy- 
ing the  genial  warmth  of  a fire.  It  seems  full  of 
happiness  to  its  very  toes. 

If,  in  washing  the  chill,  any  real  or  supposed 
deformity  is  found,  it  is  best  to  consult  the  physi- 
cian at  once,  concerning  it.  If  it  is  not  real,  it  will 
be  a relief  to  the  parents  to  know  it.  If  it  needs 
attention,  it  may  be  of  importance  that  it  should  be 
given  to  it  at  once. 

After  the  child  is  dressed,  it  may  be  laid  on  a soft 
pillow  and  allowed  to  sleep.  The  fatigue  of  being 
born,  and  then  washed  and  dressed,  is  such  that  it 
will  often  sleep  a long  time : which  it  should  be 
allowed  to  do  without  disturbance.  If  it  cries,  and 
will  in  no  way  be  pacified,  it  may  be  necessary  to 
give  it  some  food.  It  should  then  be  allowed  to 
nurse,  or  at  any  rate  to  take  its  first  lesson  in  suck- 
ing. It  is  true  that  the  mother’s  breasts  contain  but 
little  milk,  but  that  little  is  usually  sufficient  for  the 
child.  That  it  may  be  able  to  draw  the  milk,  the 


B8  CONCERNING  THE  FIRST  MONTH. 


Effect  of  the  first  milk.  How  often  the  child  may  be  nursed. 

child  should  be  placed  by  the  mother’s  side,  sup- 
ported on  a soft  pillow  by  the  nurse,  and  the  nipple 
put  in  its  mouth.  Its  head  will  require  to  be  sup- 
ported also,  and  all  of  this  should  be  done  by  the 
nurse,  that  the  mother  may  not  be  too  much  tired  by 
it.  If  the  child  succeeds  in  drawing  the  breast,  it, 
will  be  satisfied,  though  it  gets  but  very  little,  and  it 
should  then  be  allowed  to  go  to  sleep.  In  two 
hours,  if  it  is  awake  and  cries  as  if  for  food,  it  may 
be  allowed  to  try  the  other  breast  in  the  same  way. 
It  is  every  way  desirable  that  the  child  should  thus 
get  the  fluid  in  the  breasts.  Not  only  is  it  natural 
for  it  to  do  so,  but  this  first  milk  differs  from  that 
which  is  subsequently  produced,  having  somewhat  of 
a cathartic  effect.  This  is  very  desirable,  because  it 
moves  from  the  bowels  their  secretions,  deposited  in 
them  before  birth.  Should  there  continue  to  be 
sufficient  milk  in  the  breasts  to  satisfy  the  child,  it 
may  continue  to  nurse,  but  not  oftener  than  once  in 
two  hours.  After  each  time  that  the  child  takes  the 
breast,  it  is  well  for  the  nipple  to  be  carefully  dried, 
by  gently  pressing  it  between  folds  of  soft  linen. 

Occasionally  it  happens  that  there  is  not,  in  the 
mother’s  breasts,  any  fluid  at  all  for  one,  two,  or 
even  three  days  after  the  birth  of  the  child ; and  it 


CONCERNING  THE  FIRST  MONTH.  39 


What  to  do  if  the  mother  has  no  milk.  Cathartics.  Cracker  water , <&c. 

very  evidently  will  not  answer  to  allow  the  child  to 
go  so  long  as  this  without  any  nourishment  at  all. 
Infants  will,  however,  sometimes  go  twelve  hours 
without  feeding,  and  this  may  be  safely  allowed. 
When  this  is  the  case,  nurses  are  bewitched  to  give 
the  child  a teaspoonful  of  molasses  with  water,  or 
some  more  nauseous  dose,  to  move  the  bowels.  I 
very  much  prefer  to  this,  when  anything  is  necessary, 
a few  drops  (say  ten)  of  the  aromatic  syrup  of  rhu- 
barb, for  the  reason  that  molasses  very  frequently 
causes  quite  severe  pains  in  the  bowels,  while  the 
rhubarb  almost  never  does ; it  seems,  too,  to  leave  the 
bowels  in  a better  condition.  Usually,  no  medicine 
is  necessary,  or  if  used  at  all,  it  is  better  deferred  to 
the  third  day.  To  oblige  the  infant  to  commence 
life  with  a dose  of  medicine,  is  repugnant  to  one’s 
feelings,  and  often  injurious  to  the  child. 

The  preparation  of  food  for  artificial  feeding 
requires  great  care  and  attention.  The  milk  which 
usually  fills  the  breasts  should  be  imitated  as  nearly 
as  possible,  for  this  is  the  provision  which  nature  has 
made  for  the  nourishment  of  infants,  and  man  does 
not  often  improve  on  her  in  these  respects.  Cracker 
water,  panada,  arrow  root,  or  anything  else  of  this 
class,  should  not  for  a moment  be  thought  of ; for, 


40  CONCERNING  THE  FIRST  MONTH. 


The  best  substitute  for  the  mother's  milk.  Its  quantity. 

although  a child  does  not  necessarily  die  if  they  are 
given  to  it,  it  suffers  exceedingly  from  them.  The 
very  best  substitute  for  the  mother’s  milk,  till  it 
“ comes,”  is  made  by  adding  one  part  of  fresh  cream 
(country  cream,  I mean)  to  ten  of  water,  and  to  this 
add  a teaspoonful  of  loaf  sugar  for  every  gill,  mix- 
ing it  fresh  every  time.  With  this,  made  about 
milk-warm,  the  child  may  be  fed,  if  necessary,  every 
two  hours  (not  oftener),  till  the  mother’s  milk  comes, 
when  it  should  be  at  once  placed  upon  that  more 
natural  diet.  During  the  whole  time  that  it  is  thus 
fed,  it  should  be  put  to  the  breast  before  each  meal, 
that  it  may  learn  to  suck,  and  that  the  sucking  may, 
as  it  does,  hasten  the  appearance  of  the  milk. 
About  a gill  of  the  mixture  will  be  required  by  the 
child,  at  a meal,  during  these  few  days.  The  mode 
of  giving  it  to  the  child  will  be  described  in  the 
chapter  appropriated  to  artificial  feeding. 

The  flow  of  milk  being  fully  established,  the  child 
needs  no  other  food.  It  should  by  all  means  be  con- 
fined to  this,  so  long  as  it  is  sufficient  for  its  wants, 
unless,  as  very  rarely  happens,  it  does  not  agree  with 
it.  To  the  extent  that  the  natural  supply  is  insuffi- 
cient, artificial  methods  have  to  be  resorted  to,  but 
are  always  to  be  considered  as  evils,  to  be  avoided 
if  possible. 


CONCERNING  THE  FIRST  MONTH.  41 


Habits.  Of  nursing  too  often.  The  effect  on  the  mother  and  child. 

One  of  the  earliest  developments  of  the  human 
nature  of  the  new-born  infant,  is  its  facility  in 
acquiring  habits,  and  obstinacy  in  retaining  them. 
The  comfort  of  both  mother  and  child  depends  very 
much  upon  bearing  this  in  mind  from  the  first.  The 
following  directions  will  be  found  to  be  of  impor- 
tance. 

Of  JVursing. 

Once  in  two  hours  is  often  enough  for  the  new- 
born child  to  nurse  during  the  day,  and  once  in 
three  hours  during  the  night.  The  habit  of  putting 
the  child  to  the  breast  every  time  it  cries,  should  be 
shunned  for  the  sake  of  the  mother,  and  for  the  sake 
of  the  child.  On  the  part  of  the  mother  it  entails 
great  labor,  the  child  becoming  more  and  more 
exacting  as  it  grows  older,  and  being  less  easily 
contented  during  her  necessary  absences ; a more 
grave  consideration  is  that  if  the  child  is  almost 
constantly  nursing,  as  it  is  held,  it  keeps  up  a con- 
stant drain  upon  the  nervous  system  of  the  mother, 
and  allows  no  time  for  her  to  rest.  Delicate  women 
feel  this  exhaustion  exceedingly,  but  it  produces  a 
marked  effect  upon  the  strongest.  On  the  part  of  the 
child  it  is  objectionable,  because  it  does  not  allow  any 
time  for  the  stomach  to  rest.  For  the  perfect  perform- 


4:2  CONCERNING  THE  FIRST  MONTH. 


The  stomach  must  rest.  Advantages  of  good  habit. 

ance  of  the  functions  of  the  stomach,  it  is  necessary 
that  there  should  be,  after  each  meal,  sufficient  time 
allowed  for  its  complete  digestion  and  disappearance 
from  the  stomach,  together  with  a period  during 
which  that  yiscus  shall  be  empty,  before  another 
meal  follows.  Two  hours  is  the  shortest  time  in 
which  the  amount  of  milk  taken  by  a child,  at  a full 
meal,  can  be  digested,  and  the  stomach  have  any 
time  of  rest.  If,  then,  before  that  time  has  passed 
another  quantity  is  poured  in,  the  digestion  of  the 
first  is  incomplete,  while  the  stomach  is  unable  to 
grapple  with  and  subdue  the  second.  Every  one 
knows  the  effects  of  eating  too  often,  and  the  child 
is  not  exempt  from  them.  In  the  adult,  the  effect  of 
taking  the  usual  amount  of  food  during  the  day,  but 
in  smaller  quantities,  with  shorter  intervals,  is  to 
disturb  the  digestion  very  much  ; and  it  is  just  this 
evil  which  should  be  avoided  in  the  child.  Early 
attention  to  this  will  create  a habit  of  regularity, 
and  the  child  will  not  desire  to  nurse  oftener  than 
is  desirable.  All  the  annoyance  caused  by  the  child 
crying  for  the  breast,  or  insisting  upon  lying  in  the 
mother’s  arms  with  the  nipple  in  its  mouth,  is 
avoided.  Neglect  of  this  direction  will  bring  with 
it  a series  of  inconveniences,  which  will  tend  to 


CONCERNING  THE  FIRST  MONTH.  43 


Lengthening  the  interval  between  meals.  Regurgitation  not  vomiting. 

make  a slave  of  the  mother,  and  a glutton  of  the 
child. 

With  the  increase  in  the  age  of  the  child,  the 
interval  between  meals  may  be  lengthened,  so  that, 
when  the  child  is  six  months  old,  it  should  be  about 
three  hours.  The  judgment  of  the  mother  must  be 
used  in  this  matter,  for  it  is  impossible  to  lay  down 
absolute  times  for  absolute  ages,  and  expect  every  one 
to  exactly  conform  to  them.  I point  out  the  general 
principle ; it  is  the  mother  that  must  put  them  in 
execution,  adapting  them  to  the  peculiarities  of  the 
child. 

It  is  often  the  case  that  children  throw  up  a 
portion  of  the  milk  they  have  swallowed.  If  it 
occurs  immediately  after  nursing,  and  is  not  at  all 
sour,  it  is  simply  indicative  of  the  fact  that  the 
stomach  was  too  full.  As  it  contracts  to  its  proper 
dimensions,  that  digestion  may  commence,  a portion 
of  the  fluid  which  distended  it  escapes  in  the  only 
direction  possible — that  is,  by  the  mouth.  This  is 
simply  regurgitation  and  different  from  the  vomiting 
of  sickness.  The  remedy  for  it  is  to  remove  the 
child  from  the  breast  before  it  has  taken  as  much 
as  it  is  accustomed  to  draw.  If  allowed  to  continue, 
the  stomach  may  become  seriously  deranged. 


44  CONCERNING  THE  FIRST  MONTH. 


The  child  should  sleep  alone,  for  its  own  sake  and  the  mother's. 


Of  Sleeping. 

It  is  a rule  which  should  not  be  forgotten  or  dis- 
regarded, without  the  most  stringent  necessity,  that 
the  child  should  not  sleep  with  its  mother.  Here? 
again,  the  force  of  habit  must  be  borne  in  mind,  and 
the  child  must  not  be  permitted  to  learn  what  it 
must  afterwards  unlearn  with  so  much  trouble.  The 
new-born  child  should,  after  nursing,  be  laid  upon  a 
soft  pillow  away  from  its  mother,  and  allowed  to 
take  its  nap  undisturbed.  If  this  be  not  • done  at 
once,  the  difficulty  of  subsequently  commencing  it 
will  be  increased.  Thus  left  to  itself,  with  cover- 
ings suitable  to  the  season,  it  will  enjoy  a quiet  and 
refreshing  sleep  ; while  the  mother,  who  will  be  not 
a little  fatigued,  will  also  be  able  to  place  herself 
in  just  that  position  which  will  most  rest  her  ; will 
be  able  to  sleep  without  fear  of  turning  over  upon 
her  little  one  ; or,  if  she  prefers  it,  can  be  bathed  or 
take  her  meals  without  endangering  the  child’s  rest. 
But  if  the  child  is  allowed  to  sleep  by  her  side,  this 
cannot  be.  If  she  sleeps,  it  will  not  be  soundly,  or 
without  anxiety.  Her  position  will  be  constrained, 
or  if  she  moves,  it  will  be  to  disturb  the  child.  She 
cannot  eat  till  the  babe  wakes ; she  cannot  be 


CONCERNING  THE  FIRST  MONTH.  45 


Benefit  to  the  Toother.  How  mothers  are  fatigued. 

bathed  or  rubbed  while  the  child  sleeps  — and  if 
this  be,  as  is  often  the  case,  till  it  desires  to  nurse 
again,  she  finds  herself  unrecruited,  but  compelled 
to  undergo  a new  fatigue.  Both  mother  and  child, 
then,  are  from  the  first  benefited  by  sleeping  away 
from  each  other.  With  the  increase  of  the  child’s 
age,  the  advantages  of  so  doing  become  more  and 
more  apparent.  The  mother  sooner  regains  her 
strength,  and  furnishes  to  the  child  a more  abundant 
and  richer  milk.  The  child  thrives  better,  and  is 
more  healthy,  and  the  time  never  comes  when  it  has 
to  learn,  with  many  hard  turns  of  crying,  to  break 
from  its  first  habit.  Every  physician  knows  how 
apt  it  is  to  be  the  case,  that  young  mothers,  whose 
children  are  about  a year  old,  complain  of  constant 
fatigue  and  debility ; dragging  themselves  about 
only  with  great  effort,  and  sighing  for  a single  night 
of  refreshing  sleep.  With  a healthy  child,  by  atten- 
tion to  the  advice  just  given,  this  fatigue  may  be  in 
very  great  measure  avoided.  It  is  comparatively 
nothing  for  a healthy  woman,  to  nurse  a child  twice 
or  three  times  a night ; but  very  few  can  endure  the 
fatigue  entailed  upon  one  by  allowing  a child  to  lie 
upon  her  arm,  or  close  to  her  side,  for  the  whole 
night. 


£6  CONCERNING  THE  FIRST  MONTH. 


What  (he  child  should  sleep  in.  The  led  clothing.  It  should  be  dry. 

What  the  child  should  sleep  in,  is  of  less  moment. 
A large  clothes  basket  often  holds  the  pillow  and 
the  child  very  comfortably  for  a few  months,  and  has 
the  advantage  of  having  no  rockers  for  every  one  to 
strike  their  feet  against,  and  occupies  but  little 
room.  A crib  is  a very  good  thing,  though  larger 
than  is  at  first  necessary.  A cradle  is  about  the 
worst  thing,  especially  if  it  be  of  the  old  fashion, 
with  high,  solid  top,  shutting  off  every  breath  of 
fresh  air.  During  cold  weather,  if  a basket,  or 
other  low  bed  is  used,  it  should  be  placed  on  boxes 
or  chairs,  especially  during  the  night,  so  that  the 
child  may  not  be  exposed  to  the  cold  currents  which 
sweep  about  the  floor.  The  bed  should  be  soft  and 
warm,  and  the  coverings  sufficient  for  the  season, — 
light,  but  not  too  thin — warm,  but  not  too  heavy. 
It  seems  scarcely  necessary  to  do  so,  and  yet  I will 
add  that  the  most  scrupulous  care  should  be  taken 
that  the  child’s  bed  should  be  kept  dry  and  sweet. 
The  infant  should  never  be  put  into  sheets  that  are 
at  all  damp  ; and  however  much  the  nurse  may  try 
to  shirk  her  duties,  it  should  be  insisted  upon,  that 
she  should  change,  or  at  least  dry  the  sheets  and 
bed  after  every  wetting. 


CONCERNING  THE  FIRST  MONTH.  47 


Cold  baths  objectionable.  A meal  should  follow  the  bath. 


Of  Bathing. 

Every  morning  the  child  should  be  put  into  a bath. 
The  not  uncommon  idea,  that  cold  water  is  prefera- 
ble for  this  purpose,  is  erroneous.  No  doubt  a 
hearty,  stout  child  will,  if  kept  in  cold  water  but  a 
short  time,  have  sufficient  reaction  to  make  it  thor- 
oughly warm,  but  this  is  not  the  case  with  the 
majority  of  children,  if  they  are  allowed  to  remain 
in  the  water  sufficiently  long  to  be  thoroughly 
washed.  Their  pinched  features,  and  cold  extremi- 
ties, show  that  they  have  not  been  benefited,  while 
the  terror  the  sight  of  water  often  inspires  in  chil- 
dren thus  treated,  should  suggest  the  discontinuance 
of  the  practice.  If  warm  water  is  used  — and  it 
may  be  at  first  about  blood- warm  — it  will  be  found 
to  be  very  grateful  to  the  young  child.  It  is,  in  fact, 
more  like  the  condition  of  its  existence  previous  to 
birth,  than  when  it  is  wrapped  about  with  clothing. 
The  child  soon  learns  to  expect  the  bath  at  a certain 
time,  and  is  restless  unless  it  receives  it.  A bath, 
followed  by  a meal,  seems  to  be,  in  health,  a sure 
precursor  to  a sound  nap  in  the  young  child.  The 
meal  should  follow,  rather  than  precede  the  bath,  for 
this  reason  ; but  an  additional  one  may  be  found  in 


48  CONCERNING  THE  FIRST  MONTH. 


The  rule  for  bathing.  When  salt  may  be  used 

the  fact  that  unless  this  is  done,  the  bath  interrupts 
and  interferes  with  the  digestion  of  the  food  in  the 
stomach. 

The  rule,  then,  should  be  established,  that  the 
child  should  haye  a warm  bath  every  morning,  to  be 
followed  by  a good  rubbing  with  a soft  hand ; it 
should  be  dressed  and  then  be  allowed  to  nurse.  A 
nap  after  this  process,  gives  the  mother  an  opportu- 
nity to  attend  to  other  duties,  or  rest  herself  if 
fatigued.  This  system  should  be  commenced,  at 
once,  by  the  monthly  nurse,  and  carried  out  by  her. 
When  neglected — even  if  a sponge  bath  is  substituted 
for  it — it  is  sometimes  difficult  to  establish  it,  the 
good  of  the  child  being  made  to  yield  to  momentary 
convenience,  or  the  child  being  fearful  of  what  has 
become  so  strange  to  it.  For  a healthy  child,  it  is 
not  necessary  to  add  anything  to  the  water,  but 
when  it  is  feeble,  salt  may  be  of  advantage.  One  or 
two  tablespoonfuls  of  this  will  usually  be  enough 
for  the  quantity  of  water  necessary  for  the  bath. 
Nothing  else  should  be  used,  except  by  the  direction 
of  a physician.  It  seems  scarcely  necessary  to  add 
that  the  child  should  be  guarded  against  taking 
cold,  as  it  comes  dripping  out  of  the  tub.  For  this 
reason,  it  is  well  to  have  a warm,  soft  blanket 


CONCERNING  THE  FIRST  MONTH.  49 


How  to  avoid  taking  cold.  On  using  soap. 

ready  to  wrap  the  child  in  at  once,  allowing  it  to 
remain  a few  moments,  that  a portion  of  the  mois- 
ture may  be  absorbed,  and  then  opening  it  enough  to 
allow  a portion  of  the  body  to  be  wiped  dry  by  soft, 
thick  towels,  without  exposing  the  rest.  This  may 
seem  an  excessive  minuteness  of  particulars,  but 
there  is  danger,  even  of  lung  fever,  from  unnecessary 
exposure  in  this  way ; and  when  persons  are  not 
aware  of  it,  it  is  a kindness  to  caution  them. 

If  a full  bath  is  not  practicable,  for  any  reason,  a 
careful  sponging  with  warm  water  should  not  fail  to 
be  substituted  for  it.  By  many  it  is  preferred,  but  I 
think  without  good  reason. 

It  will  be  observed  that  I have  said  nothing  about 
the  use  of  soap.  The  fact  is,  that  too  much  of  it 
may  be  used,  as  well  as  too  little.  None  but  the 
blandest  variety  should  ever  be  used,  and  this  should 
be  applied  to  those  parts  in  which  there  is  especial 
need  of  cleanliness,  from  their  liability  to  become 
soiled.  A child  that  is  bathed  every  day,  does  not 
need  to  be  scrubbed  like  one  to  whom  it  is  a 
monthly  treat.  There  is  a farther  and  serious  objec- 
tion to  its  use,  from  the  fact  that  when  its  alkali  is 
in  excess,  as  is  frequently  the  case,  it  destroys  the 
natural  secretion,  which  keeps  the  skin  soft  and  plia- 
4 


50  CONCERNING  THE  FIRST  MONTH. 


Mistaken  ideas  of  the  effect  of  exposure. 

able,  and  the  surface  becomes  dry  and  rough.  Some 
cutaneous  eruptions  seem  to  owe  their  existence  to 
this  excess  of  a good  thing,  and  cannot  be  cured  till 
a more  moderate  use  is  made  of  it. 

Of  Dress . 

It  is  a consideration  of  great  moment  how  the 
child  is  dressed.  On  this,  more  than  almost  any 
one  thinks,  depends  the  future  health  of  the  individ- 
ual. No  doubt  some  children  would  live  through 
almost  everything  in  the  way  of  exposure,  but  that 
is  far  from  demonstrating  that  it  is  desirable  for  all 
to  be  subjected  to  great  risks.  It  is  often  said  the 
Spartans  were,  and  savages  are,  more  vigorous  and 
robust  than  modern  and  civilized  people,  because  of 
the  hardening  process  to  which  they  were  subjected 
in  infancy.  But  in  this  statement  (if  it  be  true  of 
the  adults,  which  is  doubtful),  no  regard  is  had  to  the 
effect  of  the  exposure  on  others.  How  many  deli- 
cate ones  must  have  yielded  to  the  trial,  which  none 
but  robust  ones  could  endure.  Yet,  to  a nation,  the 
lives  of  those  delicate  ones  are  often  of  the  greatest 
moment.  An  athlete  is  not,  necessarily,  a wise  man ; 
neither  is  one  who  is  not  equal  to  the  arduous  labors 
of  the  field,  or  the  contests  of  war,  or  the  exertions 


CONCERNING  THE  FIRST  MONTH.  51 


Depressing  effect  of  cold.  Materials  far  the  dress  at  different  seasons. 

required  of  those  who  “ go  down  to  the  sea  in  ships/’* 
of  necessity  a useless  citizen.  Quite  the  reverse  is 
true,  and  the  safety  of  the  delicate  is  a matter  of 
great  moment. 

The  same  is  the  fact  with  regard  to  families  ; and 
among  those  in  which  the  hardening  by  exposure  is 
resorted  to,  the  success  is  not  such  as  to  make  it  very 
attractive.  I have  before  alluded  to  the  fact,  that 
cold  is  a depressant ; having  a tendency  when  con 
tinued,  to  lessen  the  vital  force,  and,  in  time  to 
destroy  it.  This  is  taught  by  the  very  rudiments  of 
physiology.  Why,  then,  should  a young  child  be 
exposed  to  such  influences,  when  there  is  in  fact,  no 
occasion  for  it  ? 

The  child’s  dress  is  a matter  of  fashion,  differing 
at  different  times,  and  in  various  places.  During 
the  heat  of  Summer,  it  requires  to  be  light  and 
unirritating.  Yery  delicate  linen,  or  cotton,  seem  to 
be  the  best  materials  for  it ; the  linen  being  the 
cooler.  If  there  is  any  tendency  to  diarrhoea,  or  if, 
with  this  clothing,  the  child’s  feet  are  habitually 
cold,  flannel  must  be  added.  That  which  is  to  be 
next  its  body,  as  for  a shirt,  should  be  very  soft  and 
delicate,  to  avoid  irritating  the  surface  and  bringing 
out  troublesome  eruptions.  That  which  is  not  to  be 


52  CONCERNING  THE  FIRST  MONTH. 


Protest  against  fashion’s  dictates. 

immediately  in  contact  with  it,  as  for  petticoats,  may 
be  thicker,  though  it  should  still  be  soft.  As  the 
weather  grows  colder,  the  proportion  of  woollen 
garments  should  be  increased  ; the  effort  being  so 
to  regulate  it  as  to  keep  the  child  just  comfortable, 
not  too  cold  nor  too  warm.  For  a country  so 
extended  as  ours,  it  is  impossible  to  specify  the 
particulars  of  dress  which  shall  be  adapted  to  the 
almost  arctic  winters  of  the  North,  and  the  torrid 
climate  of  the  South,  with  all  the  intervening  grades 
of  heat.  What  has  been  said,  is  sufficient  for  the 
direction  of  persons  of  common  sense.  Against 
one  thing,  however,  I must  protest,  and  that  is  the 
excessive  exposure  of  children,  by  blind  obedience 
to  fashion,  in  making  their  dresses  very  low  in  the 
neck,  and  with  very  short  sleeves.  I know  it  is 
very  beautiful ; I am  very  fond  of  seeing  and  kiss- 
ing their  little  fat  necks,  and  I like  to  squeeze  their 
dumpy  arms.  Still  I the  more  earnestly  protest 
that,  except  in  constant  warm  weather,  when  fires 
are  not  needed,  or  when  the  whole  house  is  of  a 
uniform  warmth,  it  is  a very  great  exposure.  I 
shall  again  allude  to  the  subject,  when  I speak 
of  children  that  are  older  ; and  therefore  here  add 
only,  that  where  the  climate  is  cold,  or  where  sud- 


CONCERNING  THE  FIRST  MONTH.  53 


The  night  dress.  Fresh  air. 

den  changes  of  temperature  are  frequent,  the  child’s 
dress  should  come  well  up  in  its  neck,  and  at  least 
to  its  elbows.  My  experience  teaches  me,  however, 
that  almost  any  direction  will  be  followed  by 
mothers,  sooner  than  this.  But  this  fact,  does  not 
lessen  its  importance. 

Hitherto  I have  spoken  of  the  day  dress  of  the 
infant.  The  night  dress  should  be  made  with 
reference  to  the  same  points.  The  very  common 
exposure  from  throwing  off  the  bed  clothes,  requires 
this  to  be  made  rather  thicker  in  proportion.  It 
should  be  loose  enough  not  to  bind  anywhere,  but 
still  close  enough  to  turn  with  the  movements 
of  the  body.  A shirt  and  a night-gown  are  usually 
sufficient,  though  a petticoat  may  sometimes  be  nec- 
essary, in  addition.  During  the  Winter,  the  night- 
gown should  be  of  flannel,  thin,  or  thick,  accord- 
ing to  the  climate ; for  it  is  evident  that  in 
Maryland,  there  will  not  be  the  same  necessity  for 
warm  covering  that  there  is  in  Maine. 

Of  Exposure  to  the  Fresh  Air . 

By  the  close  of  the  first  month  it  is  well,  if  the 
weather  is  mild,  to  accustom  the  child  to  be  carried 
out  of  doors  by  its  nurse,  for  a longer  or  shorter 


54  CONCERNING  THE  FIRST  MONTH. 


Influence  of  light.  The  best  rule. 

walk,  every  day.  The  dress  must  be,  of  course, 
varied  from  that  which  it  has  worn  in  the  house  ; 
the  head  being  covered,  and  the  chest  and  feet 
being  protected  from  the  cold.  It  is  quite  sur- 
prising, to  one  who  has  not  observed  it,  how  soon 
infants  learn  to  expect  their  walk,  and  to  what  an 
extent  it  affects  their  temper  during  the  whole  day. 
It  is  not  necessary  to  describe  the  influence  of  pure 
air  upon  all  persons.  It  is  only  necessary  to  say 
that  children  show  more  readily  than  others  how 
important  it  is  ; when  carefully  protected  from  being 
chilled,  they  will,  during  this  period,  enjoy,  and  be 
benefited  by,  being  carried  out  of  doors,  even  in 
the  coldest  climate  of  this  country.  The  irritability 
which  all  are  subject  to,  sometimes  disappears  at 
once  under  its  influence. 

It  is  not  only  the  air,  but  the  light,  which  is 
beneficial,  and  which  should  be  carefully  furnished 
to  children.  Plants  that  grow  in  dark  places,  like 
cellars,  show  the  change  which  insufficient  light 
produces  in  them.  Somewhat  similar  effects  are 
produced  in  children,  if  they  are  not  abundantly 
furnished  with  this  vital  stimulus. 

The  best  rule  is,  for  the  child  to  be  carried  out 
every  day  that  is  pleasant,  all  the  year  round ; 


CONCERNING  THE  FIRST  MONTH.  55 


The  proper  time  for  the  walk  in  Winter  and  in  Summer. 

in  Winter,  about  the  middle  of  the  day,  and  in  the 
sunshine — in  Summer,  as  early  as  convenient  in  the 
morning,  after  the  sun  has  risen  sufficiently  to  drive 
off  the  night  fogs  and  dampness. 

During  the  hottest  part  of  the  day,  in  the  warm 
season,  it  is  better  for  the  child  to  be  at  home,  or 
if  carried  out  of  doors,  its  nurse  should  sit  quietly 
with  it  in  the  shade  of  a tree.  A refreshing  sleep 
is  often  thus  enjoyed  by  the  child. 

No  one,  who  has  seen  the  marked  effects  some- 
times produced  by  a walk  or  ride,  upon  sick  or 
convalescent  children,  can  for  a moment  doubt  its 
importance  to  them.  One  can  thus  understand,  if 
farther  argument  is  necessary,  why  the  healthy  child 
should  always  be  accustomed  to  that,  which  in  dis- 
ease, or  after  the  disease  has  passed  away,  is  its  best 
restorative. 


56 


OF  WET  NURSES. 


The  mother  cannot  always  nurse  her  own  child. 


Chapter  IV. 

OF  WET  NURSES. 

In  what  has  heretofore  been  said,  it  has  been 
presumed  that  the  child  is  nursed  by  its  mother,  and 
this  is  evidently  the  natural  way  of  nourishing  the 
infant.  This  is  not  always  possible,  for  it  occasionally, 
though  very  rarely,  happens  that  the  mother’s  milk 
disagrees  entirely  with  the  child,  and  to  save  its  life, 
it  is  necessary  to  find  some  other  food  for  it.  Some- 
times, too,  in  consequence  of  accidents  at  the  time  of 
birth,  or  subsequently ; or  from  some  other  reason, 
the  mother’s  milk  disappears,  and  her  breasts  yield 
nothing  for  her  offspring.  At  other  times  the 
mother’s  health  is  so  affected  by  nursing  that  it 
becomes  a necessity  to  choose  between  her  safety 
and  the  risk  to  the  child  of  changing  its  diet.  In 
such  a case,  when  every  means  has  been  tried  in 


OF  WET*  NURSES. 


5T 


The  mother  sometimes  more  heartless  than  a heathen. 


vain,  to  restore  her  to  health  it  is  necessary  to  incur 
this  risk  to  the  child,  rather  than  sacrifice  her  life. 

Sometimes  this  method  is  considered  necessary 
that  the  mother  may  retain  her  beauty,  keep  back 
the  traces  of  time’s  progress,  or  not  be  interrupted 
in  her  attendance  upon  the  dissipations  of  fashiona- 
ble life.  It  does  not  seem  credible,  and  yet  it  is 
undoubtedly  true,  that  occasionally  a mother  is*  so 
hard-hearted,  so  indifferent  to  the  good  of  her 
offspring,  or  so  given  up  to  fashion  and  frivolity, 
that  she  prefers  her  own  selfish  gratification  to  the 
welfare  of  her  child.  Strange  and  cruel ! I con- 
fess that,  to  my  mind,  there  is  a fearful  resemblance 
between  the  devotee  of  fashion,  who  obliges  her 
child  unnecessarily  to  incur  the  perils  of  artificial 
feeding,  and  the  Buddhist  devotee  who  drops  her 
child  into  the  sacred  river  Ganges.  The  one  does 
it  for  her  own  gratification,  the  other  that  the  child 
may  sooner  enter  a more  blissful  state.  Oh,  enlight- 
ened, Christian  woman ! do  not  a deed  worse  than 
that  of  the  heathen  infanticide ! 

When  it  is  impossible  for  the  mother  to  nurse  her 
child  herself,  it  remains  either  to  get  another  woman 
to  nurse  it — that  is,  a wet  nurse  — or  to  feed  it  in 
some  other  way.  To  the  latter  is  applied  the  term 


58 


OF  WET  NURSES. 


A wet  nurse  to  he  preferred  to  feeding.  Annoyances  of  wet  nurses. 

of  artificial  feeding.  The  wet  nurse  is  to  he  pre- 
ferred, for  the  child’s  good,  to  feeding,  hut  a choice 
is  not  always  practicable.  I will  first  speak  of  wet 
nurses. 

These  are  by  mothers  almost  always  considered 
as  nuisances.  I mean  when  they  come  to  live  in  the 
house  with  the  mother.  There  is  almost  universally 
a certain  jealousy  on  the  mother’s  part  of  any  one 
who  nurses  her  child,  and  from  this  cause  little 
things  become  great  evils.  The  nurse  on  the  other 
hand  usually  feels  her  importance  to  its  full  extent, 
and  assumes  airs,  as  annoying  as  they  are  imperti- 
nent. She  must  have  her  own  way  for  fear  that 
crossing  her  will  make  her  angry,  and  suggests  to 
the  mother  that  that  will  make  the  milk  hurt  the 
child.  She  must,  according  to  her  statement,  have 
sound  sleep,  and  the  best  of  everything  to  eat,  and 
in  enormous  quantities,  so  that  she  may  furnish  a 
rich  milk  to  the  child.  In  short,  she  avails  herself 
of  the  mother’s  love  for  her  child  to  tyrannize  over 
her,  and  to  make  herself  as  comfortable  as  she  can 
desire  to  be.  Wet  nurses  usually  intend  to  live 
on  the  fat  of  the  land.  Their  wages,  too,  are 
quite  high,  so  that  to  those  in  moderate  circum- 
stances almost  every  inconvenience  seems  to  centre 


OF  WET  NURSES 


59 


When  the  nurse  may  take  the  child  to  her  home. 

in  them.  In  a city  a wet  nurse  should  never 
be  permitted  to  take  the  child  to  her  own  house, 
away  from  its  mother’s  oversight.  The  tempta- 
tions to  neglect  it  are  too  great  for  its  safety.* 

In  the  country,  where  the  mother  can  daily  visit 
the  child,  it  will  answer,  if  the  nurse  has  lost  her 
own  child,  or  if  the  nurse  has  milk  enough  for 
two  children.  It  is  but  nature,  where  two  are 
nursed,  that  the  foster-child  should  come  off  second 
best ; it  going  short  if  either  does,  and  being  fed  if 
either  must.  Still,  knowing  all  these  inconveniences 
and  annoyances,  I do  not  hesitate  to  say  that,  if  it 
is  necessary  to  take  the  infant  from  the  mother’s 
breast,  every  effort  should  be  made  to  obtain  for  it 
a healthy  wet  nurse.  It  is  the  less  of  the  two  evils, 
so  far  as  the  child  is  concerned,  and  should  be 
cheerfully  borne  for  its  good. 

In  selecting  a wet  nurse,  it  should  be  borne  in 
mind  that  the  condition  of  her  health,  as  well  as  her 
moral  character,  will  have  a certain  influence  upon 
the  child.  She  should  be  perfectly  healthy,  and  to 
ascertain  that  this  is  so,  it  is  frequently  necessary  to 

* At  the  Demilt  Dispensary,  where  I have,  in  the  course  of  the  year,  some  1200 
children  come  under  my  care,  I find  that  if  one  is  brought  in  who  is  not  the 
nurse’s  offspring,  it  rarely  recovers  so  rapidly  as  others,  and  if  very  sick  is  almost 
sure  to  die  from  neglect. 


60 


OF  WET  NURSES. 


How  to  select  a wet  nurse.  The  age  of  the  milk. 

cause  her  to  be  examined  by  a physician.  There  are 
so  many  particulars  which  are  of  importance,  but 
which  do  not  attract  the  notice  of  unprofessional 
persons,  that  this  is  the  safest  course.  She  should 
be  free  from  the  taint  of  hereditary  or  other  con- 
stitutional disease,  that  the  child’s  constitution  may 
not  be  contaminated. 

The  mother  may  be  aided,  however,  in  making 
her  selection  by  bearing  in  mind  these  points  : — 

1.  The  nurse’s  milk  should  be  of  about  the  same 
age  with  the  mother’s ; that  is,  her  child  should 
have  been  born  at  about  the  same  time  with  the 
one  she  would  nurse.  The  milk  furnished  by  a 
woman  varies  at  different  times,  changing  from  the 
first  that  is  drawn,  to  the  last.  A woman  with  a 
new  breast  of  milk — that  is,  who  has  just  been 
confined — is  not  fitted  to  nurse  a child  who  is  six 
months  old  ; neither  is  a woman  with  a six  months’ 
breast  of  milk,  the  best  fitted  to  nurse  one  just  born. 
Exact  equality  in  age  is  rarely  to  be  obtained, 
without  sacrificing  some  other  points  of  equal 
importance.  This  is,  however,  a consideration  of 
less  importance  after  the  infant  is  six  months  old. 
After  that  time  it  is  safer  to  choose  a woman  who 
has  not  nursed  more  than  six  months. 


OP  WET  NURSES. 


61 


A childless  woman  to  he  preferred. 

2.  If  there  are  two  women  — in  other  respects  of 
equal  qualification — one  of  whom  has  a child  still 
living,  which  she  has  put  out  to  nurse,  but  the  other 
of  whom  has  lost  her  infant, — without  hesitation 
select  the  latter.  This  difference,  too,  should  lead 
one  to  make  the  same  choice  against  some  of  the 
more  unimportant  advantages  possessed  by  the  other. 
The  reason  is  a very  simple  one.  The  woman  who 
can,  for  the  sake  of  money,  leave  her  child  to  the 
care  of  others  during  its  early  infancy,  must  have 
moral  impediments  to  being  a good  nurse.  Some- 
times, it  is  true,  she  may  be  in  a condition  as  to 
means,  which  compels  her  to  such  a course,  but  then 
her  motherly  instincts  will  lead  her  not  unfrequently 
to  visit  her  own  child,  and  of  course  to  nurse  it. 
The  danger  of  contracting  contagious  disease  is,  in 
this  way,  very  great.  Her  heart  will  pine  for  her 
own  forsaken  one,  and  should  it  fall  sick  she  will,  as 
she  ought  to  do,  abandon  all  her  advantages  of  situ- 
ation and  her  dependent  foster  child,  whether  it  be 
in  the  middle  of  Summer  or  not,  that  her  own  child’s 
life  may  not  be  sacrificed.  The  nurse  who  has  lost 
her  child,  has  none  of  these  duties  to  another ; and 
although  her  own  grief  will  for  a time  sadden  her, 
she  finds  a solace  for  it,  in  transferring  her  affection 


62 


OF  WET  NURSES. 


The  age  of  the  nurse.  Her  temperament.  Her  breast. 

to  the  child  which  has  taken  its  place.  I have  often 
seen  nurses  who,  under  such  circumstances,  seemed  to 
love  their  nursling  with  a mother’s  affection. 

3.  The  age  of  the  nurse  should  not  usually  be 
under  twenty  years,  or  over  twenty-eight,  this  being 
about  the  period  at  which  they  are  most  apt  to  yield 
a rich,  healthy  milk. 

4.  A woman  with  brown  or  black  hair,  should  be 
selected  in  preference  to  one  with  light  or  red  hair  ; 
and  of  the  last  two,  the  former  should  have  the  pre- 
ference. The  reason  is  simply  this,  that  light  haired 
women,  although  they  often  have  more  milk  than 
those  who  are  of  a darker  complexion,  do  not  fur- 
nish in  it,  so  much  nourishment ; their  milk  is  more 
watery,  though  it  may  be  more  abundant.  Red 
haired  women  are  apt  to  be  quicker  to  become 
angry,  and  to  have  tempers  not  so  well  regulated  as 
others. 

5.  The  nurse  should  be  of  good  form  and  plump, 
with  a white,  hard  breast,  marbled  with  bluish  veins, 
and  a nipple  of  good  size,  perfectly  free  from  cracks 
and  eruptions,  with  gums  firm  and  red,  and  with 
good  teeth.  The  general  appearance  of  the  face 
should  be  that  of  health. 

6.  After  what  has  been  said  of  the  influence  of 


OF  WET  NURSES. 


63 


Wet  nurses  rarely  need  malt  liquors. 


the  mother’s  temper  upon  her  child,  it  is  scarcely 
necessary  to  add,  that  it  is  desirable  to  select  for  a 
nurse,  a woman  of  gentle  disposition,  and  of  a good 
degree  of  intelligence,  rather  than  a stupid  and 
irascible  one. 

It  may  be,  to  some  readers,  o£  use  to  say,  that  wet 
nurses  very  rarely  need  beer,  ale,  or  other  malt 
liquor,  to  enable  them  to  perform  their  duties. 
These  drinks  are  often  necessary  to  a feeble  mother, 
to  enable  her  to  bear  the  drain  upon  her ; but  a 
woman  who  requires  them  ought  not  to  become  a 
wet  nurse.  The  habit  of  taking  stronger  liquors,  as 
brandy,  gin,  or  whiskey,  is  a good  and  sufficient 
reason  for  rejecting  a nurse.  Their  influence  on  the 
child  is  injurious. 

When  all  these  points  are  carefully  attended  to, 
the  mother  has  done  all  in  her  power  to  provide  her 
child  with  the  most  natural  and  best  nourishment  for 
it.  The  nurse’s  diet  and  habits,  should  be  controlled 
by  the  mother,  and  regulated  in  accordance  with  the 
principles  which  I have  laid  down  for  her  guidance. 


/ 


64 


OP  ARTIFICIAL  FEEDING. 


Necessity  justifies  it.  Nature  to  be  imitated.  Ass's  milk. 


Chapter  V. 

OF  ARTIFICIAL  FEEDING. 

When  it  becomes  necessary  to  resort  to  artificial 
feeding  (and  necessity  alone  justifies  one  in  so 
doing),  it  should  be  understood  that  a very  great 
labor  is  undertaken.  Success  in  it  is  only  to  be 
obtained  by  the  most  constant  watchfulness  and 
attention  on  the  part  of  the  mother,  whether  she 
takes  care  of  her  child  herself,  or  employs  a dry 
nurse. 

The  mother’s  milk  is  the  natural  food  for  the 
infant,  and  to  draw  it  from  the  breast  is  the  natural 
mode  of  taking  it.  In  artificial  feeding,  both  of 
these  conditions  should  be  imitated  as  closely  as 
possible. 

The  milk  of  the  ass  more  frequently  agrees  with 
children  than  that  of  other  animals  (the  reasons  for 


OP  AKTIFICIAL  FEEDING. 


65 


Goat's  milk.  How  to  choose  a goat. 

this  will  presently  appear),  but  in  this  country  it  is 
very  rarely  to  be  obtained.  The  cow  and  the  goat 
are  the  animals  most  depended  upon  for  milk,  and 
that  of  both  differs  from  woman’s  milk,  and  requires 
some  allowance  to  be  made  on  this  account.  The 
selection  of  the  animals  from  which  the  milk  comes 
is  the  first  thing,  and  is  sometimes  a matter  of  great 
importance.  The  goat  should  not  be  depended 
upon,  unless  good  cow’s  milk  is  not  to  be  had.  Its 
milk  has  a strong  and  disagreeable  flavor,  though  it 
is  said  that  one  soon  becomes  accustomed  to  it,  and 
rather  misses  it  in  other  milk.  But  the  goat  can  be 
bought  for  a lower  price  than  a cow,  requires  less 
food,  and  can  be  kept  in  a smaller  place.  A good 
milker  will  give  quite  enough  for  an  infant,  and  can 
be  kept  even  in  cities  without  very  great  trouble. 
In  the  country,  too,  it  picks  up  a good  living  where 
other  animals,  unless  it  be  sheep,  would  starve.  Of 
course  it  furnishes  fresh  milk  for  the  child  twice  a 
day,  and  without  adulteration.  In  buying  a goat 
for  this  purpose,  choose  one  that  is  young,  of  good 
size,  and  whose  kid  is  quite  young.  Those  of  a pure 
white  color  give  milk  almost  free  from  the  disagree- 
able flavor  to  which  I have  alluded,  and  are,  there- 
fore, to  be  decidedly  preferred.  The  breed  that 
5 


66 


OF  ARTIFICIAL  FEEDING. 


A new  milch  cow  preferable . 

have  no  horns  have  been  said  to  give  sweeter  milk 
than  others,  but  this  is  not  proved  to  be  correct. 
Boiling  almost  entirely  removes  the  taint. 

If  a cow  is  to  be  selected,  let  it  be  the  best  new 
milch  cow  that  can  be  found.  The  milk  of  the  cow 
which  has  not  long  since  calved,  seems  to  agree  bet- 
ter with  the  stomach  of  the  young  child  than  any 
other.  Milk  should,  in  Summer  at  least,  be  brought 
from  it  twice  a day,  that  it  may  be  perfectly  fresh. 
It  is  a matter  of  great  moment  to  obtain  the  milk 
from  the  same  animal  constantly,  and  the  precaution 
to  secure  this  should  therefore  be  taken.  If  one 
owns  the  cow,  this  is,  of  course,  easy,  but  in  a city 
or  large  town,  where  the  milk  has  to  be  bought,  it  is 
not  so  readily  accomplished.  Honest  milkmen  can, 
however,  usually  be  found  who  will  furnish  it,  and 
the  good  of  the  child  would  repay  one  for  any 
amount  of  labor  in  hunting  such  an  one  up.*  The 
milk  should  be  kept  in  a cool  place,  and,  if  possible, 
by  itself.  So  many  things  will  communicate  their 
flavor  to  it,  by  being  shut  up  in  the  same  refrige- 
rator with  it  for  a few  hours  only,  that  this 
precaution  is  not  to  be  neglected.  The  -child  is 

* I knew  of  a woman  in  New  York  who  made  something  more  than  her  living  by 
keeping  a few  cows  to  furnish  milk  for  children  exclusively. 


OF  ARTIFICIAL  FEEDING. 


67 


The  milk  should  be  sweet. 


Boiling  it. 


offended  by  the  flavor  thus  communicated  to  it,  and 
it  rejects  its  food  on  this  account.  Is  it  necessary 
to  add  that  it  should  never  be  given  to  the  child 
unless  it  is  perfectly  sweet?  Neglect  of  this  will  at 
once  be  evident,  in  its  effect  upon  the  bowels. 
During  the  Summer,  when  it  is  most  difficult  to  keep 
milk  sweet,  it  should  be  boiled  as  soon  as  it  arrives 
unless  it  has  just  been  taken  from  the  cow.  The 
changes  to  which  it  is  subject,  are  accelerated  by  the 
jostling  of  the  long  ride  which  it  takes  before  it  is 
served  by  the  milkman,  and  these  changes  are,  in  a 
measure,  checked  by  boiling.  Of  course  it  should 
not  be  allowed  to  burn,  and  requires  only  to  be 
brought  to  the  boiling  point,  not  to  be  continued  at 
it.  For  children  that  are  constipated,  boiled  milk 
is  not  well  adapted,  as  it  serves  to  increase  that 
difficulty,  but  the  same  peculiarity  makes  it  more 
beneficial  to  those  who  have  any  tendency  to 
diarrhoea. 

I have  said  that  cow’s  and  goafs  milk  is  not 
exactly  like  woman’s  milk.  The  difference  will  be 
more  readily  appreciated  by  a careful  perusal  of  the 
following  table,  which  I believe  to  be  entirely 
accurate.  It  will  be  seen  that  the  milk  of  each  of 
the  animals  of  which  I have  spoken  is  included. 


68 


OP  ARTIFICIAL  FEEDING. 


Comparison  of  four  kinds  of  milk. 


Table  showing  the  Properties  of  Different  Kinds  of 


Milk, 

Properties.  Human.  Cow.  Goat.  Ass. 

Casein  (cheese),. ...  2.95  4.48  4.02  1.82 

Butter, 5.20  8.13  3.82  0.11 

Sugar, 6.34  4.77  5.28  6.08 

Saline  matters, 0.45  0.60  0.58  0.34 

Water, 85.06  87.02  86.80  91.65 


100.00  100.00  100.00  100.00 
This  shows  that  cow’s  milk  has  more  cheese  in  it 
than  woman’s  milk,  with  less  butter  and  sugar. 
The  same  is  true  of  goat’s  milk,  though  the  pro- 
portion of  cheese  is  not  quite  so  great  as  in  cow’s 
milk.  Ass’s  milk  has  less  cheese,  butter,  and  sugar, 
than  woman’s — that  is,  it  is  in  every  respect  poorer. 
If  this  were  used,  it  would  be  necessary  to  give  the 
child  a larger  quantity  at  a time,  or  to  add  some- 
thing to  it  to  make  it  richer.  The  cheese  (casein) 
in  cow’s  milk  is  the  ingredient  which,  on  account  of 
its  difficulty  of  digestion  and  its  excess,  it  is 
especially  desirable  to  lessen ; while  it  is  equally 
necessary  to  increase  the  portion  of  fatty  matter 
which,  in  the  table,  is  called  butter,  and  at  the  same 
time  increase  the  proportion  of  sugar.  The  cream 
which  rises  on  milk  when  it  is  allowed  to  stand  in  a 


OP  ARTIFICIAL  FEEDING. 


69 


Cream.  The  best  imitation  of  woman's  milk  The  top  of  the  miUc. 

cool  place,  consists  mainly  of  the  fatty  portions  of 
the  milk,  — as  every  one  knows  who  has  seen  the 
cream  carefully  skimmed  off,  that  by  churning  the 
butter  may  be  entirely  separated. 

In  this  there  is  a smaller  proportion  of  cheese,  less 
sugar,  and  less  water.  If  now  we  wish  to  imitate 
the  proportion  of  these  ingredients  as  found  in 
woman’s  milk,  we  take  cream  and  add  to  it  warm 
water,  sufficient  to  make  it  about  as  thin  as  that — 
which  is  thinner  than  cow’s  milk, — and  sugar  suffi- 
cient to  make  it  a little  sweeter  than  cow’s  milk. 
The  imitation  may  be  thus,  with  care,  made  very 
exact,  and  every  one  who  has  ever  had  the  charge  of 
a child  that  depends  on  artificial  feeding,  knows  that 
chis  is  the  mixture  which  is  most  apt  to  agree  with  the 
child  that  is  new  born,  or  whose  stomach  and  bowels 
have  become  deranged.  The  reason  of  it  is  now 
clear. 

As  it  is  not  often  possible  to  feed  a child  entirely 
with  cream,  more  of  the  milk  is  taken,  but  the  direc- 
tions given  are  always  to  take  the  top  of  the  milk, 
that  is  to  give  an  increased  proportion  of  butter, 
and  to  diminish  the  quantity  of  cheese. 

The  milk  should  be  prepared  fresh  every  time  it  is 
wanted.  The  temperature  should  be  raised  by 


70 


OP  ARTIFICIAL  FEEDING. 


How  to  warm  the  milk.  Proportions  of  milk , water , and  sugar. 

adding  warm  water,  instead  of  heating  the  milk  and 
water  after  they  are  put  together,  and  should  be 
just  that  of  milk  that  is  fresh  from  the  cow.  Some 
care  is  necessary  to  adjust  this,  and  sometimes  a 
thermometer  is  necessary  to  ascertain  the  exact 
warmth.  If  little  milk  is  used,  the  water  should  not 
be  much  warmer  than  the  mixture  is  to  be,  but  if 
little  water  is  added  it  must  be  almost  boiling. 

As  to  the  way  of  preparing  the  milk,  it  will . be 
sufficient  to  say  that  at  first,  when  cow’s  milk  is 
used,  it  is  well  to  mix  one  part,  by  measure,  of  the 
top  of  the  milk,  with  two  parts  of  water  (that  is, 
make  it  one-third  milk),  and  sweeten  it  with  refined 
sugar.  It  should  not  be  made  excessively  sweet,  but 
still  should  taste  decidedly  of  the  sugar.  To  a gill 
of  milk  and  water,  a teaspoonful  of  sugar  will  be 
quite  enough,  and  frequently  less  will  answer. 
When  the  sugar  is  in  excess,  the  milk  is  very  apt  to 
turn  sour  on  the  stomach.  If  the  bowels  are  consti- 
pated, brown  sugar  may  be  substituted  for  the  white, 
but  a very  coarse  sugar  should  not  be  used,  as  it 
sometimes  produces  colics.  When  the  child  is  very 
delicate,  the  mixture  before  described,  should  be 
first  used,  that  is,  one  part,  by  measure,  of  rich 
cream  to  ten  of  water,  a teaspoonful  of  sugar  being 


OF  ARTIFICIAL  FEEDING. 


71 


Increasing  the  quantity  of  milk.  Substitutes  for  milk. 

added  to  every  gill  of  the  mixture.  The  proportion 
of  cream  can  be  increased,  and  milk  gradually 
added  as  the  child  gains. 

With  the  child’s  increase  in  age  it  will  be  neces- 
sary to  increase  both  the  quantity  and  the  strength 
of  its  food.  But  as  no  precise  rule  can  be  given  for 
the  quantity  children  may  be  allowed  to  take,  so  no 
exact  time  can  be  set  down  for  increasing,  its 
strength  or  richness.  One  child  will  eat  about  as 
much  during  the  first  month,  as  a more  delicate  one 
will  in  its  sixth  month,  and  these  particulars  must  be 
left  to  the  common  sense  of  mothers.  The  addition 
of  cream,  as  well  as  the  increase  of  the  proportion 
of  milk  renders  the  mixture  richer. 

When  goat’s  milk  is  used,  it  should  be  reduced  till 
it  is  of  the  same  strength  as  that  of  which  I have 
spoken  above.  Cow’s  milk  furnishes  the  best  stand- 
ard, and  to  this  it  is  easy  to  bring  other  milk.  The 
table  shows  that  the  proportions  of  cheese  and  butter 
do  not  vary  much  from  cow’s  milk,  but  the  goat’s  is 
a little  sweeter. 

Several  other  substances  are  used  occasionally,  in 
preference  to,  or  in  place  of  milk.  These  are  arrow- 
root,  flour-gruel,  cracker-water,  or  a sort  of  panada 
made  of  crackers,  but  all  of  these  are,  unless  it  be 


72 


OP  ARTIFICIAL  FEEDING. 


Objections  to  them.  How  to  give  the  milk  to  the  child,.  Imitate  nature. 

in  very  exceptional  cases,  to  be  avoided.  None  of 
the  substances,  which  in  these  various  preparations 
are  dissolved  in  or  mixed  with  the  water,  are  so 
easily  digested  by  the  infant  as  milk,  and  none  of 
them  contain  so  exactly  the  elements  which  it  needs 
to  make  it  thrive.  Considering  them  as  unfit  for  the 
child  less  than  six  months  old,  I shall  not  dwell  upon 
them,  but  again  advise  mothers  not  to  use  them. 

Having  thus  described  the  fittest  food  for  the 
child  that  is  not  to  be  nursed  by  its  mother,  or  some 
other  woman,  the  question  occurs,  how  is  it  to  be 
given  to  the  child.  Herein  is  involved  no  slight 
task.  The  child  is  deprived  of  its  natural  method  of 
feeding,  and  how  shall  a substitute  be  found  for  it. 

Almost  any  apothecary’s  shop  will  furnish  a great 
variety  of  contrivances,  intended  to  take  the  place 
of  the  mother’s  breast  and  nipple,  but  in  my  opinion 
almost  all  of  them  are  deficient  in  one  or  other 
respect.  To  enumerate  them  all  would  be  impos- 
sible, as  it  is  unnecessary,  since  it  will  suffice  to  show 
the  general  principles  on  which  a selection  should 
be  made.  Believing  that  we  shall  do  the  best  when 
we  imitate,  as  nearly  as  possible,  the  conditions 
under  which  the  infant  naturally  obtains  its  food,  1 
would  lay  down  the  rules  following. 


OF  ARTIFICIAL  FEEDING. 


73 


Rules  for  selecting  apparatus.  Advantage  of  the  child's  sucking. 

1.  Whatever  apparatus  is  selected,  it  should  be 
one  which  will  require  the  infant  to  suck  in  order  to 
obtain  the  milk.  This  will  cut  off  a very  large 
number  of  contrivances,  in  which  a short  tube  is 
placed  in  the  mouth  of  a bottle.  These  compel  the 
nurse  to  tip  the  bottle  up,  and  the  milk  just  runs 
into  the  child’s  mouth.  To  this  my  objection  is,  that 
it  is  important  for  the  infant,  as  well  as  the  adult, 
that  its  food  should  be  mixed  with  the  secretions 
(the  saliva)  of  the  mouth,  which  does  not  take  place 
when  it  runs  down  the  throat  as  fast  as  the  child 
can  swallow,  withoht  any  exertion  on  its  part.  The 
milk,  therefore,  is  not  in  its  most  favorable  state  for 
digestion.  But  beside  this,  the  child  is  apt  to  have 
its  stomach  filled  to  a greater  degree  than  is  neces- 
sary, and  this  also  tends  to  interfere  with  digestion, 
producing,  not  unfrequently,  more  or  less  severe 
diarrhoea.  It  is,  perhaps,  a less  important  consider- 
ation that,  from  the  position  in  which  the  infant  is 
usually  placed,  there  is  no  little  danger  of  its  being 
strangled — I do  not  mean  to  death,  but  so  as  to 
produce  annoying  fits  of  coughing. 

2.  The  apparatus  should  be  easily  kept  sweet.  It 
will  be  found  that  one  of  the  greatest  difficulties  to 
be  contended  with  in  artificial  feeding,  is  to  keep 


74 


OP  ARTIFICIAL  FEEDING. 


The  apparatus  must  he  easily  changed.  Objections  to  sponges , corks,  <£c» 

everything  in  which  the  milk  is  put,  from  becoming 
offensive.  The  temperature  at  which  it  is  necessary 
to  have  the  milk  when  the  child  feeds,  hastens 
changes  in  it,  and  these  are  rapidly  communicated 
to  new  milk,  if  the  old  is  allowed  to  come  in 
contact  with  it.  This  rule  excludes  all  those 
arrangements  of  which  a piece  of  sponge,  or 
other  soft  substance,  so  placed  as  to  require 
the  milk  to  pass  through  it,  composes  a part.  The 
sponge  is,  in  itself,  when  new,  sufficient  to  disgust  an 
infant  by  the  taste  which  it  communicates  to  the 
milk.  Whether  this  or  other  soft  substances  are 
used,  it  will  be  found  to  be  impossible  to  keep  them 
sweet,  after  they  have  been  used  more  than  a day  or 
two,  no  matter  how  much  trouble  is  taken  to  have 
them  cleansed.  More  or  less  of  the  milk  will  be 
detained  in  their  meshes,  and  either  become  sour, 
or  give  out  that  stale  and  rancid  odor,  which  is 
more  offensive.  The  same  objection  holds  to  those 
contrivances  which  do  not  allow  the  cork,  which  is 
to  stop  the  bottle,  to  be  readily  changed.  The  cork 
becomes  saturated  with  the  milk,  and  to  remove  it 
and  substitute  another  one  for  it,  is  too  difficult  a 
thing  for  most  persons  to  do.  This  rule  also 
requires  the  vessel  which  holds  the  milk,  to  be  of 
such  a form  that  it  is  easily  cleansed. 


OP  ARTIFICIAL  FEEDING. 


75 


Exertion  required.  Material.  Prepared  teats.  India-rubber  nipples. 

3.  The  child  should  be  able  to  obtain  the  milk 
with  about  the  same  effort,  and  about  as  rapidly  as 
one  does  that  is  nursing.  This  rule  is,  perhaps,  a 
corollary  to  the  first,  but  it  merits  the  enforcement 
of  a separate  place.  The  rapidity  and  quantity, 
can  be  judged  of  by  the  frequency  with  which  the 
child  swallows. 

4.  The  material  should  be  such  that  the  tube  or 
mouth-piece  will  not  break  in  the  child’s  mouth,  or 
be  liable  to  cut  or  injure  its  tongue  and  gums,  if 
slightly  injured.  I have  seen  glass  tubes  which 
were  very  objectionable  on  this  account.  Any  other 
material  that  could  injure  the  child  by  corroding,  or 
in  any  other  way,  should  be  excluded.  Thus,  copper 
would  be  unfit  to  use  in  making  a tube.  The  pre- 
pared teats  of  the  calf  are  objectionable,  because  it  is 
necessary  to  keep  them  in  alcohol,  and  although  the 
teat  is  soaked  in  water  before  it  is  used,  it  cannot 
usually  be  done  thoroughly  enough  to  take  out  all 
the  alcohol.  In  passing,  I may  say  that  I have 
never  seen  infants  appear  to  like  them.  The  india- 
rubber  nipples  and  mouth-pieces  do  not  seem  to  be 
liked  any  better,  and  they  have  been  objected  to  on 
the  ground  that  the  sulphur  which  is  mixed  with  the 
rubber  irritates  the  bowels,  tending  to  produce  diar- 


76 


OP  ARTIFICIAL  FEEDING. 


Position.  The  lest  apparatus.  Its  advantages. 

rlioea.  I have  never  seen  this  effect,  but  should  be 
watchful  for  fear  they  might  injure  a delicate  child 
in  this  way.* 

5.  The  position  of  the  child  while  feeding,  should 
be  as  nearly  that  of  a child  that  nurses  as  is  possible. 
This  is  a consideration  for  the  child’s  comfort,  and, 
I believe,  greatly  conduces  to  it. 

The  best  arrangement  which  I have  ever  seen  for 
this  purpose,  is  a silver  tube  long  enough  to  reach 
nearly  to  the  bottom  of  the  nurse  bottle,  with  a 
mouth-piece  of  good  size,  surrounded  with  a shield, 
against  which  the  lips  press.  It  is  secured  in  the 
bottle  by  a cork,  through  the  middle  of  which  it 
passes,  but  which  can  be  readily  changed  for  another, 
and  thus  perfect  sweetness  of  this  portion  is  easily 
and  cheaply  secured.  It  is  prevented  from  passing 
through  the  cork  by  another  shield,  which  is  firmly 
secured  to  the  tube.  A smaller  tube  passes,  by  the 
side  of  the  main  tube,  from  this  second  shield  down- 
ward a sufficient  distance  to  pass  through  the  cork. 
This  is  for  the  purpose  of  allowing  air  to  enter  the 
bottle  as  fast  as  milk  is  drawn  from  it,  on  precisely 
the  same  principle  that  a vent  hole  is  made  in  a cask 
of  vinegar,  or  other  fluid,  when  it  is  to  be  drawn  off. 


* I have  now  seen  this  rubber  nipple  used  for  eight  years  since  the 
above  was  written,  and  never  with  any  bad  result.  — 2nd  Edition. 


OF  ARTIFICIAL  FEEDING. 


77 


How  to  keep  the  apparatus  sweet. 


The  advantages  of  this  over  other  tubes  are,  that  it 
is  easily  kept  clean ; that  the  child  does  not  have 
the  milk  poured  down  its  throat,  so  that  it  has  to 
swallow  as  fast  as  it  can  to  avoid  being  strangled, 
and  yet  does  not  have  to  draw  so  hard  as  to  be 
exhausted  by  fatigue,  before  it  has  got  enough  to 
eat ; that  the  position  of  the  child  in  its  nurse’s  arms 
is  very  nearly  the  natural  one,  disposing  it  comforta- 
bly to  sleep,  and  permitting  it  to  enjoy  the  exquisite 
luxury  of  falling  asleep  as  it  feeds,  without  danger 
of  being  overflowed  by  the  milk  ; that  it  is,  in  short 
as  near  an  approach  to  the  natural  arrangement  as 
is  possible. 

I do  not  know  whose  invention  this  is,  but  that  is 
unimportant ; neither  do  I speak  of  its  merits  from 
theory  alone.  I have  repeatedly  seen  it  used  with 
the  most  complete  satisfaction,  which  is  more  than  I 
can  say  of  any  other  apparatus. 

Still  this  requires  a good  deal  of  attention, 
though  less  than  others.  The  bottle  should  be 
thoroughly  washed  out  with  warm  water  after 
every  meal,  whether  it  be  in  the  day  or  night. 
Once  or  twice  in  the  twenty-four  hours,  it  should  be 
allowed  to  stand  for  some  time,  filled  with  water 
containing  a half  teaspoonful  of  carbonate  of  soda, 
or  as  much  saleratus.  When  the  cork  has  the  least 


78  OF  ARTIFICIAL  FEEDING. 

Other  methods. 

sour  or  tainted  smell,  it  should  be  removed,  and  a 
fresh  one  substituted  for  it.  Allowing  it  to  soak  for 
a day  or  two  in  soda  or  saleratus  water,  will  make 
it  sweet  again.  Three  or  four  should  thus  be  kept 
on  hand,  fitted  to  the  bottle,  and  with  holes  for  the 
tube  to  pass  through.  Water  should  be  drawn  into 
the  tube,  after  every  time  that  it  is  used,  sufficient  to 
wash  it  out  thoroughly.  This,  also,  should  be  put  in 
soda  water  every  day  for  an  hour  or  two.  If  it 
becomes  clogged,  an  exceedingly  fine  knitting- 
needle,  or  a piece  of  wire  should  be  used  to  force 
out  the  obstruction.  The  same  precautions  will  be 
necessary  for  any  other  tube  and  bottle  that  may  be 
used,  in  order  to  keep  them  sweet. 

The  question  may  arise,  whether  or  not  some 
other  method  of  feeding  will  not  answer  as  well. 
Other  methods  are  resorted  to,  such  as 'feeding  with 
the  spoon,  or  from  a cup.  By  either  of  these,  the 
first  and  third  rules  are  violated,  and  the  child  suf- 
fers in  consequence.  Although  robust  children  will 
get  along  in  this  way,  it  almost  always  disagrees 
with  those  who  have  not  so  vigorous  digestive  pow- 
ers. I do  not  know  that  it  is  necessary  to  say  more 
of  them. 


OF  THE  SECOND  SIX  MONTHS.  79 


Of  the  care  of  the  child  during  its  first  dentition. 


Chapter  YI. 

OF  THE  SECOND  SIX  MONTHS. 

What  lias  hitherto  been  said,  refers  more  especially 
to  the  period  embraced  by  the  first  six  months  after 
birth.  To  some  of  the  principles  which  have  been 
laid  down.,  I shall  have  occasion  to  refer  again,  but 
others  are-  chiefly  important  within  the  period  thus 
limited.  This  limitation  is  not  a mere  arbitrary 
division,  but  one  which  seems  to  be  pointed  out  by 
nature.  It  rarely  happens  that  the  teeth  of  infants 
begin  to  appear  before  the  seventh  month,  though 
they  occasionally  do,*  but  during  that  month,  one  or 
more  almost  always  show  themselves  above  the 

* I had,  about  six  years  ago,  a singular  instance  of  early  dentition.  At  the  time  the 
child  was  born  I noticed  nothing  peculiar  in  its  appearance,  except  that  it  had  a very 
large  amount  of  thick  black  hair  on  its  head.  On  visiting  the  mother  the  next  day 
but  one,  she  showed  me  two  teeth  which  had  come  through,  and  which  must  have 
been  raised  above  the  level  of  the  jaw  at  the  time  of  the  birth.  They  were  the  mid- 
dle teeth  of  the  lower  jaw,  and  were  never  of  any  use.  I saw  them  in  the  child’s 
mouth  nine  months  after  its  birth,  but  then  lost  sight  of  the  family. 


80  OF  THE  SECOND  SIX  MONTHS. 


When  the  teeth  may  he  expected  and  their  order. 

gums.  From  the  fact  that,  during  this  period, 
children  are  particularly  liable  to  disease,  it  seems 
well  to  mark  it  by  a separate  division. 

Mothers  always  want  to  know  at  what  time  to 
expect  .teeth  to  appear,  and  for  this  reason  I give 
the  following  statement — premising  it,  however,  by 
saying  that  healthy  children  may  have  them  appear 
either  sooner  or  later  than  is  here  set  down  ; so  that 
the  fact  that  certain  teeth  have  not  appeared  at  a 
certain  time,  is  no  proof,  in  itself,  that  the  child  is 
not  healthy. 

The  four  front  teeth,  two  in  the  middle  of  each 
jaw,  usually  appear  about  the  seventh  month,  but 
sometimes  earlier,  and  frequently  later.  Ordinarily, 
those  in  the  lower  jaw  come  through  first. 

The  teeth  on  each  side  of  these  appear  next,  and 
between  the  seventh  and  tenth  months ; the  usual 
order  being  for  the  two  in  the  lower  jaw  to  come 
first. 

Soon  after  the  end  of  the  twelfth  month,  the  first 
grinding  teeth  come  through,  a space  being  left 
between  each  of  them  and  those  which  have  before 
appeared.  There  are  four  of  these,  two  in  each  jaw. 

Between  the  fourteenth  and  twentieth  months  the 
spaces  left  in  the  jaws  are  filled  by  the  canine  teeth, 


OF  THE  SECOND  SIX  MONTHS.  81 


Eye  and  stomach  teeth.  Last  grinding  teeth.  Table  of  dentition. 

of  which  there  are  also  four  in  all.  The  two  in  the 
lower  jaw  are  usually  called  stomach  teeth,  those  in 
the  upper  jaw  being  known  as  eye  teeth,  though  they 
have  no  particular  connection  either  with  the  eyes  or 
stomach. 

Another  grinding  tooth  appears  beyond  each  of 
those  already  seen,  at  some  time  between  the 
eighteenth  and  thirty-sixth  month,  and  these  com- 
plete the  first  set,  or  milk  teeth,  as  they  are  called. 

Except  for  the  four  front  teeth  in  each  jaw,  which 
usually  appear  first  in  the  lower  jaw,  there  is  no 
regularity  as  to  those  in  the  one  or  the  other  appear- 
ing first.  As  a general  rule,  when  those  in  one  jaw 
are  coming  through,  the  corresponding  teeth  in  the 
other  are  not  much  behind.  And  so  it  is  with  the 
corresponding  teeth  on  opposite  sides  of  the  same  jaw. 

Perhaps  it  may  simplify  the  description  to  put  the 
succession  of  teeth  in  a tabular  form,  thus  : 

Table  showing  the  time  at  which  the  teeth  of  the  first  set 
{milk  teeth)  may  be  expected  to  appear . 

Two  front,  in  each  jaw  (incisors),  appear  about  the 
seventh  month, — lower  teeth  first. 

One  tooth  next  each  of  the  preceding,  two  in  each 
jaw  (lateral  incisors),  from  the  seventh  to  the 
tenth  month, — lower  teeth  first. 

6 


82  OF  THE  SECOND  SIX  MONTHS 


Effect  of  dentition  on  a healthy  child. 


First  grinding  teeth  (anterior  molars),  about  the  close 
of  the  twelfth  month, — irregular  in  their  order. 
Stomach  and  eye  teeth  (canines),  from  the  fourteenth 
to  the  twentieth  month, — irregular  in  their  order. 
Back  teeth  (posterior  molars),  from  the  eighteenth  to 
the  thirty-sixth  month, — irregular  in  their  order. 

A healthy  child  that  is  nursing,  does  not  usually 
give  much  indication  of  disturbance  during  the  time 
in  which  the  teeth  are  appearing,  except  by  an 
excessive  flow  of  saliva,  or  as  it  is  commonly  called 
drooling.  Perhaps  it  will  have  two  discharges  from 
its  bowels,  in  the  twenty-four  hours,  instead  of  one, 
and  it  may,  occasionally,  be  a little  feverish  or  rest- 
less, desiring  to  bite  the  nurse’s  fingers,  or  whatever 
else  is  smooth  and  sufficiently  hard.  If  the  gums 
are  examined  at  this  time,  it  will  be  found  that  the 
ridge,  which  has  previously  been  visible  along  the 
edge  of  the  jaw,  has  entirely  disappeared,  and  the 
gum  is  full  and  rounded.  After  a few  days,  the 
point  of  a tooth  makes  its  way  through  the  mem- 
brane which  has  covered  it,  and  the  remainder  of 
its  crown  soon  appears.  The  slight  disturbance 
which  has  previously  existed  then  disappears,  and 
returns  only  when  another  tooth  is  about  to  come 
through. 


OP  THE  SECOND  SIX  MONTHS.  83 


Various  disturbances.  Severe  pain.  Its  effects. 

When  the  process  of  teething  goes  on  in  this  man- 
ner, we  have  the  natural  and  most  desirable 
condition'.  But  this,  unfortunately,  does  not  always 
prove  to  be  so  favorable.  A diarrhoea  comes  on,  or 
there  are  twitchings  and  startings  during  sleep — the 
child  sometimes  awaking  in  terror ; or  convulsions 
occur,  and  show  to  what  a degree  the  nervous  sys- 
tem of  the  child  is  disturbed  by  the  process. 

But  I will  treat  of  the  ordinary  disturbances  in 
the  order  of  their  severity. 

When  the  child  has  been,  and  still  remains  per- 
fectly well,  there  will  sometimes  be  excessive  pain 
produced  simply  by  the  pressure  of  the  tooth  on  the 
gum.  This  not  only  keeps  the  child  from  sleeping, 
but  from  obtaining  a moment's  rest.  The  pain  is 
constant  and  severe,  and  if  the  child’s  mouth  is 
examined  there  will  be  found  to  be  a prominent 
place  in  the  gum,  as  if  a tooth  were  simply  covered 
by  a strong  membrane,  like  that  which  lines  the  rest 
of  the  mouth.  And  this  is  the  actual  condition  of 
things.  If  this  is  allowed  to  go  on  without  being 
interfered  with,  the  child  will  suffer  extremely,  and 
if  he  continues  perfectly  well  the  tooth  will  finally 
penetrate  the  gum,  and  relief  will  follow.  But  not 
unfrequently,  by  the  exhaustion  and  irritation  which 


84:  OP  THE  SECOND  SIX  MONTHS. 


The  remedy.  Cutting  the  gums  useful. 

are  thus  produced,  the  nervous  system  of  the  child 
becomes  deranged,  and  convulsions  follow.  Now, 
to  avoid  all  of  these  evils,  physicians  desire  to 
hasten  the  very  process  which  nature  is  slowly 
accomplishing ; that  is,  by  means  of  a kind  of  knife, 
called  a gum  lancet,  they  divide  the  gum  so  as  to  let 
the  tooth  through.  Nothing  can  be  simpler  than 
this,  or  more  strictly  in  accordance  with  the  natural 
process,  and  yet  I do  not  know  of  an  operation  that 
is  more  frequently  objected  to.  When  the  gum  is  in 
the  condition  which  I have  described,  there  cannot 
possibly  be  any  harm  resulting  from  its  division,  pro- 
vided it  is  properly  done.  A cross  cut  (like  this,  X ) 
should  be  made  directly  on  the  top  of  the  tooth,  and 
down  to  it.  No  blood  vessel  can  in  this  way  be 
divided,  and  so  there  can  be  no  danger  of  bleeding, 
and  the  not  uncommon  belief,  that  it  is  injurious  to 
the  child,  can  have  no  foundation.  When  lancing 
the  gums  has  been  injurious,  it  has  almost  always 
been  from  its  being  done  when  unnecessary,  or  from 
the  operator’s  having  cut  in  the  wrong  place. 
Although  I have  had  occasion  to  do  this  many  hun- 
dreds of  times,  I have  never  yet  seen  any  bad  effects 
follow,  and  sometimes  the  relief  is  very  striking. 
When  a medical  student,  I found  one  of  my  little 


OF  THE  SECOND  SIX  MONTHS.  85 


Illustration.  How  to  stop  bleeding  if  it  occurs. 

nephews  — a fine,  stout  boy  — crying  as  if  in  the 
greatest  agony,  and  his  mother  said  that  he  had  con- 
tinued to  do  so  for  several  hours.  Upon  looking 
into  his  mouth,  I saw  a large  tooth  in  the  condition 
which  I have  before  described,  the  gum  being  drawn 
tightly  over  it.  Not  having  a gum  lancet  with  me, 
I ventured  to  divide  the  membrane  with  my  pen- 
knife, carefully  covering  its  point,  so  that  it  should 
not  wound  his  tongue.  The  child  was  crying  when 
I began,  but  actually  laughed  as  soon  as  the  gum 
was  divided,  and  before  I could  get  the  knife-blade 
out  of  his  mouth.  So,  too,  I have  seen  children,  who 
seemed  to  be  in  a high  fever,  become  at  once  natu- 
rally cool  and  playful  after  dividing  the  gum.  For 
these  reasons,  I would  urge  mothers  to  be  careful 
that  a judicious  physician  should  be  called  upon  to 
look  at  the  gums  of  a child  that  becomes  restless 
and  fretful  at  the  period  of  teething,  and  if  he 
thinks  they  should  be  cut,  he  should  be  allowed  to 
do  it.  It  may,  perhaps,  be  best  to  add,  that  if  there 
is  much  bleeding  from  the  gums  after  cutting  them, 
it  can  usually  be  stopped  by  taking  a clean  and  soft 
linen  towel,  and  pressing  it  with  the  finger  firmly 
against  the  gum.  If  this  does  not  stop  it,  a little 
powdered  alum  may  be  put  on  the  finger  and  pressed 


86  OF  THE  SECOND  SIX  MONTHS. 


Attention  to  the  condition  of  the  bowels. 

against  it,  or,  what  is  better,  if  an  apothecary  is  near, 
a little  tannin  may  be  got  and  used  in  the  same  way. 
In  the  country,  when  neither  of  these  are  at  hand,  a 
strong  tea  may  be  made  with  white  oak  bark,  or  even 
with  hemlock  bark,  and  a soft  piece  of  linen  saturated 
with  it  can  be  firmly  pressed  against  the  gum.  If 
the  bleeding  does  not  stop  soon,  the  physician  should 
be  again  sent  for  ; but  I repeat,  that  where  the  ope- 
ration is  required,  and  is  properly  performed,  more 
than  slight  bleeding  very  rarely,  if  ever,  occurs,  and 
this  is  the  only  danger  that  is  to  be  apprehended. 

During  the  time  in  which  teeth  are  pressing,  care 
should  be  taken  that  the  child’s  bowels  should  be 
open — -that  is,  that  there  should  be  at  least  one  full 
movement  from  them  every  day.  Two,  even,  may 
be  allowed  to  occur,  but  when  there  are  habitually 
more  than  this,  and  more  especially  when  these  are 
very  loose,  watery,  and  offensive,  the  child  should 
be  carefully  attended  to.  It  is  not  necessary  to 
attempt  to  explain  the  mode,  it  is  sufficient  to  state 
the  fact,  that  in  consequence  of  the  pressure  of  the 
teeth  against  the  gums  before  they  penetrate  them, 
there  arises  a relaxed  condition  of  the  bowels. 
Now,  many  physicians  will  say  that  this  is  beneficial 
and  that  to  stop  the  child’s  diarrhoea  will  endanger 


OP  THE  SECOND  SIX  MONTHS.  87 


Diarrhoea  to  be  checked.  Its  dangers.  Injurious  effect  of  the  common  opinion. 

its  life.  This,  I do  not  hesitate  to  say,  is  erroneous, 
and  appears  to  be  one  of  those  sayings,  or  customs, 
handed  down  from  one  to  another,  and  repeated  in 
books  without  due  thought  upon  the  subject.  A 
constipated  condition  of  the  bowels  is  to  be  avoided, 
but  there  is  no  more  reason  for  allowing  the  oppo- 
site condition  to  exist.  With  constipation,  the 
danger  is  that  feverishness  will  be  constant,  and 
that  a condition  will  arise  that  will  produce  con- 
vulsions. But  with  a continuous  diarrhoea,  there  is 
danger  of  the  child’s  being  prostrated,  and  that  just 
at  the  time  at  which  he  should  be  increasing  in 
strength  and  in  flesh.  Convulsions  frequently 
supervene  upon  a protracted  diarrhoea ; and  in 
many  parts  of  our  country,  if  the  Summer  comes 
round  while  the  child  is  allowed  to  remain  in  this 
condition,  cholera  infantum  suddenly  seizes  upon  the 
little  one  and  makes  him  its  victim. 

I dwell  upon  this  point  the  more,  because  I know 
it  is,  as  I have  said,  the  very  common  opinion  that  a 
diarrhoea,  at  this  period,  not  only  does  no  harm, 
but  really  does  much  good,  and  I am  sure  that  many 
lives  are  lost  every  year  in  consequence  of  this 
belief.  During  the  month  of  August,  1856, 1 saw  at 
the  Demilt  Dispensary,  and  prescribed  for,  nearly 


88  OF  THE  SECOND  SIX  MONTHS. 


Other  effects  of  dentition. 

two  hundred  children,  the  great  majority  of  whom 
were  suffering  from  diarrhoeas.  Of  those  which 
were  teething,  the  majority  had  been  allowed  to 
grow  weaker  and  weaker  from  the  repeated  dis- 
charges, because  of  this  very  common  opinion,  and 
several  had  arrived  at  that  low  state  which  is 
beyond  the  reach  of  medicine.  In  the  others,  free 
division  of  the  gum  where  teeth  were  pressing,  and 
the  use  of  appropriate  remedies,  more  or  less  quickly 
checked  it,  and  brought  back  the  child  to  that  con- 
dition from  which  it  would  never  have  been  allowed 
to  depart,  but  for  this  common  and  erroneous  belief. 
This  opinion  prevails  not  only  among  the  classes 
who  seek  relief  at  our  public  institutions,  but  among 
those  who  are  more  intelligent. 

At  other  times,  the  effects  of  the  growth  of  the 
teeth  are  manifested,  not  on  the  bowels  alone,  but 
(either  with  or  without  diarrhoea)  upon  the  nervous 
system,  and  we  have  restlessness,  contractions  of  the 
muscles  about  the  mouth — that  is,  involuntary 
twitchings— starting  during  sleep,  and  sometimes 
even  a crying  out,  as  if  from  fear.  When  these 
conditions  arise,  and  continue,  there  is  more  or  less 
danger  of  convulsions  occurring,  and  it  is  therefore 
the  safest  way  to  consult  a physician  concerning 


OF  THE  SECOND  SIX  MONTHS.  89 


Increased  danger  from  feeding.  Synopsis. 

them.  In  this  case  it  is  usually  necessary  to  divide 
the  gum  and  to  give  some  internal  remedies,  accord- 
ing to  the  condition  of  the  bowels,  for  I have  said  it 
may  be  accompanied  either  by  diarrhoea  or  consti- 
pation. 

If  the  child,  instead  of  nursing,  is  fed  from  a 
bottle,  there  is  much  more  danger  of  derangement 
of  the  bowels,  and  consequent  derangement  of  the 
nervous  system ; so  that  such  an  one  requires  much 
more  careful  watching,  and  regulation  of  its  diet. 

For  convenience,  this  synopsis  of  what  has  been 
said  on  this  subject  may  be  useful : — 

1.  If  the  child  is  nursing,  and  seems  to  be  per- 
fectly well,  no  interference  is  necessary.  It  will 
sometimes  be  grateful  to  it  to  rub  its  gums  with  the 
finger. 

2.  If  the  child  has  long  turns  of  crying,  or  does 
not  seem  to  be  well,  its  gums  should  be  examined, 
and  if  a tooth  is  pressing,  the  gum  over  it  may  need 
to  be  cut  freely. 

3.  When  diarrhoea  occurs  it  should  be  checked, 
so  that  there  are  not  more  than  two  or  three  dis- 
charges a day,  and  these  natural,  not  watery.  The 
gums  should  also  be  cut,  if  necessary. 

4.  If  there  are  twitchings  about  the  face,  or 


90  OF  THE  SECOND  SIX  MONTHS. 


Dress.  When  to  shorten  it.  Stockings. 

violent  startings  during  sleep,  the  gums  should  be 
examined,  and,  if  necessary,  cut.  A warm  bath  may 
be  given  to  the  child  just  before  it  goes  to  bed,  and 
if  this  fails,  the  physician  had  better  see  the  child. 

Of  the  Dress  of  the  Child  from  the  sixth  to  the 
twelfth  month. 

The  same  general  principles  which  have  pre- 
viously been  given  upon  this  point,  must  continue  to 
guide  the  mother  ; that  is,  the  dress  should  be  such 
as  not  to  interfere  with  the  growth  of  the  child,  by 
being  too  tight,  or  to  injure  it  by  being  either  too 
warm  or  too  cool.  In  general  I may  add,  that  it  is 
usually  during  this  period  that  children  learn  to 
creep,  an4  sometimes  to  walk.  For  this  reason,  it  is 
desirable  to  shorten  their  dresses,  if  they  have  pre- 
viously been  long,  so  that  their  feet  are,  when  the 
legs  are  straight,  just  below  the  hems  of  the  dress 
and  petticoats.  If  this  is  done,  it  will  be  necessary 
to  add  coverings  for  the  feet,  which  will,  of  course,  be 
much  more  exposed  to  the  cold.  Soft  stockings  of 
cotton,  or  woollen,  according  to  the  season  and 
climate,  and  light  shoes,  should  be  put  on.  Neither 
of  these  should  be  tight,  for  the  constant  compres- 
sion of  the  feet  would  interfere  with  their  nutrition 


OF  THE  SECOND  SIX  MONTHS.  91 


Garters. 


Night  caps. 


The  diet. 


and  growth.  India-rubber  bands  are  sometimes 
used  for  garters  to  hold  up  their  stockings.  These 
are  not  unfrequently  injurious,  by  encircling  the  leg 
so  closely  as  to  compress  the  veins  and  arteries,  and 
thus  interfering  with  the  supply  of  blood  to,  and 
nutrition  of,  the  parts  below.  Night  caps  are  at 
this  time,  as  in  fact,  during  the  whole  period  of 
early  childhood,  not  only  unnecessary,  but  injurious. 

When  the  dress  is  shortened,  especial  care  must 
be  taken  that  the  feet  are  kept  covered  when  the 
child  goes  out  of  doors.  It  is  sometimes  well  to  leave 
the  cloak  long,  for  a time,  after  the  dresses  are 
cut  off. 

Of  the  Diet , Exercise,  and  Habits  of  the  Child  dur- 
ing the  Second  Six  Months. 

Under  the  most  desirable  circumstances,  the  child 
continues  to  be  nursed  during  the  whole  of  this 
period  ; and  when  this  is  the  case,  the  same  precau- 
tions and  rules  should  be  observed  as  during  the 
first  six  months.  Not  unfrequently,  however,  the 
mother  finds  that  she  cannot,  for  some  reason, 
continue  to  nurse  her  child,  and  she  should  then 
endeavor  to  find  a suitable  wet  nurse  for  it. 
Whether  she  resorts  to  this  help,  or  to  artificial 


92  OP  THE  SECOND  SIX  MONTHS. 


Nursing  in  part.  Occasional  importance  of  it.  Hygienic  care. 

feeding,  her  guide  must  he  the  principles  before 
stated.  If  her  supply  of  milk  continues,  though  not 
sufficient  to  support  the  child,  she  may  combine  the 
two  methods — nursing  it  to  the  extent  of  her  ability, 
and  feeding  it  as  little  as  will  make  up  her  defi 
ciency.  When  this  happens  to  be  the  case,  it  is 
well  for  the  mother  to  continue  to  nurse  the  child, 
although  she  can  supply  to  it  but  one  or  two  meals 
a day.  Much  more  should  she  take  this  course,  if 
Summer  is  approaching,  for  it  is  often  of  the  greatest 
importance,  when  a child  is  attacked  by  diarrhoea, 
that  its  mother  should  be  able  to  nurse  it.  Its 
chance  for  life  is  tenfold  greater,  than  if  it  were 
entirely  weaned. 

The  general  hygienic  treatment  of  the  child 
should  be  regulated  as  I have  advised  for  the  first 
six  months.  Its  bathing, — its  exercise — or  rather 
excursions  into  the  open  air, — its  sleeping,  all 
should  be  carefully  attended  to.  Perhaps  one  direc- 
tion may  be  added,  concerning  its  going  out  doors. 
As  the  child  grows  heavier,  a little  wagon  is  usually 
resorted  to,  to  relieve  the  nurse.  Now,  if  the 
weather  is  at  all  cool,  there  is  great  danger  that  the 
child  will  suffer  from  cold.  This  I frequently  see 
in  the  children  whom  I meet  in  the  streets  taking 


OF  THE  SECOND  SIX  MONTHS.  93 


The  nurse  may  carry  the  child.  Objections  to  wagons. 

excursions  in  this  way,  and  the  cause  of  it  is  simple. 
The  nurse,  by  walking,  keeps  up  an  active  circula- 
tion of  her  blood,  and  a good  degree  of  warmth 
while  the  child,  more  sensitive  to  cold,  and  becom- 
ing quickly  chilled,  sits  entirely  inactive,  and  in  just 
those  circumstances  which  tend  to  make  its  blood 
circulate  slowly.  If  the  nurse  stops  to  talk,  as 
nurses  will  do,  the  child  is  not  more  exposed — 
perhaps  not  so  much,  for  she  sooner  appreciates  the 
coldness  of  the  air  than  when  she  continues  to 
walk — but  we  can  more  clearly  appreciate  the 
danger  there  is  of  its  being  chilled.  It  is  better,  in 
all  but  quite  warm  weather,  to  have  the  nurse  carry 
the  child,  so  that  it  may  be  warmed  by  the  heat  of 
her  body,  unless  she  be  very  faithful  end  attentive, 
so  as  to  notice  whether  or  not  it  is  too  cold. 

In  the  house,  it  is  very  desirable  that  the  child 
should  not  be  held  in  the  lap  all  the  time.  In  fact, 
it  should  be  taught,  during  its  first  two  months,  to 
lie  upon  a bed,  or  some  other  soft  place,  and  amuse 
itself.  It  is  better  for  the  mother  and  nurse,  who  in 
this  way  are  able  to  rest,  and  it  is  better  for  the 
child,  because  it  learns  to  throw  its  hands  about,  to 
kick  its  legs  out,  and  thus  to  obtain  just  the  exercise 
which  it  needs  for  encouraging  the  growth  of  the 


94  OF  THE  SECOND  SIX  MONTHS. 


Of  habits.  Illustration. 

limbs.  After  it  is  six  months  old,  it  will  do  to 
accustom  it  gradually  to  lying  on  the  floor  (unless 
there  are  cold  currents  of  air  blowing  across  it),  for 
in  this  way,  with  its  play-things  about  it,  it  will 
learn  first  to  roll,  and  then  to  creep  after  them. 
With  the  increase  of  exercise  and  development, 
there  will  follow  efforts  to  walk.  None  of  these 
modes  of  progression  need  be  taught  to  the  child, 
usually,  for  he  finds  them  out  as  early  as  is  good 
for  him. 

During  this  period,  the  child  should  be  treated 
with  firm  gentleness,  not  with  excessive  indulgence 
and  subsequent  severity, — but  should,  even  thus 
early,  learn  that  the  parent  is  to  rule.  It  is  not  to 
be  expected  to  obey  orders,  but  there  are  many 
little  things  which  a child  will  do,  if  it  has  its  own 
way,  which  will  annoy  its  attendant  excessively,  if 
allowed,  and  which  can  usually  be  prevented  without 
much  difficulty.  The  most  common  habit  of  this 
kind,  which  will  serve  as  an  illustration  of  the  whole, 
is  that  of  making  a great  disturbance,  if  it  is  not 
at  once  given  every  thing  that  it  desires.  A child 
will  want  every  bright  thing  which  strikes  its  eye, 
and  if,  at  first,  always  allowed  to  have  it,  sooner  or 
later  the  time  will  come  when  it  must  be  denied. 


OF  THE  SECOND  SIX  MONTHS.  95 


How  to  rule  the  child.  Treatment  after  punishment. 

Then  screams,  struggles,  and  persisting  efforts  to 
obtain  it  will  follow.  If  the  mother  gives  up  to 
the  child  ever  so  little,  the  young  tyrant  will  try  the 
same  measures  the  next  time,  till  finally  he  will 
become  a nuisance  to  every  body  near  him  from  this 
single  fact.  Now,  there  is  no  necessity  of  whipping 
the  child.  If  proper  care  is  taken  to  teach  him,  at 
first,  that  no,  though  said  gently  and  with  smiles, 
means  that  it  really  cannot  be  indulged,  there  is 
rarely  any  subsequent  difficulty.  But  if  this  has  not 
been  taught,  and  the  child  will  not  be  pacified,  it  is 
best  to  put  him  down  on  the  floor,  or  in  his  bed, 
and  let  him  cry  till  he  stops.  Doing  this  once  or 
twice  will  make  him  realize  that  it  is  of  no  use  to 
try  to  rule,  and  he  will  become  submissive.  He  is 
not  sick,  and  there  is  no  danger  of  his  crying  him- 
self into  convulsions.  He  ought  not,  however,  to  be 
left  alone  in  the  room  at  this  time,  for  this  may 
frighten  him  so  that  he  cries  from  fear,  not  disap- 
pointment. When  taken  up  after  getting  quiet,  there 
should  be  no  trace  of  anger  or  reproof  remaining  on 
the  part  of  the  parent,  but  more  than  usual  efforts 
should  be  made  to  amuse  him,  though  with  a careful 
avoidance  of  the  vicinity  of  the  coveted  object, 
which  has  been  the  cause  of  his  discipline.  It  is 


96  OP  THE  SECOND  SIX  MONTHS. 


The  dose  stool . Habit  of  using  it. 

surprising,  to  an  inexperienced  person,  how  much  a 
very  young  child  learns  in  this  way,  and  how  soon, 
if  care  is  not  taken,  these  little  folks  rule  their 
parents.  It  is  said,  I know  not  how  correctly,  that 
American  parents  are  more  faulty  in  this  respect 
than  those  of  Europe.  Certainly  there  is  enough 
among  us  to  be  corrected. 

It  will  not  be  amiss  to  say  here,  that  towards  the 
latter  part  of  this  period,  the  attempt  may  be  made 
to  give  the  child  the  habit  of  sitting  upon  a chair 
with  a vessel  beneath,  when  it  is  to  have  a discharge 
from  its  bowels,  instead  of  using  its  diapers.  It 
cannot  always  be  accomplished  at  this  early  age, 
but  if  the  child  has  learned  to  sit  alone,  it  usually 
can.  This  is  the  mode.  The  mother  should  notice 
at  what  time  the  child’s  bowels  usually  move — it 
being  the  case  almost  always  that  they  are  pretty 
constant  to  a certain  time.  Anticipating,  then,  the 
discharge  by  a few  minutes,  by  sitting  the  child  on 
its  close  stool,  in  an  easy  position,  it  will  occur  then. 
A few  days  will,  by  the  repetition  of  the  occurrence, 
give  the  child  the  idea  intended  to  be  conveyed; 
and  after  that  time  when  it  feels  the  necessity  for  it, 
it  will  ask  for  the  chair.  So  great  an  increase  of 
comfort  is,  in  this  way,  afforded  to  the  child  and  the 


OP  THE  SECOND  SIX  MONTHS. 


97 


Habit  continued. 

attendants,  that  success  well  repays  considerable 
effort. 

It  may,  in  the  same  way,  be  taught  to  ask  for  the 
chair  when  it  desires  to  pass  its  water ; but  this  is 
more  difficult  because  the  discharge  comes  with 
more  irregularity. 


98 


THE  SECOND  YEAR. 


Teeth  still  coming. 


Chapter  VII. 

THE  SECOND  YEAR. 

During  the  second  year  teeth  still  continue  to 
appear,  as  has  previously  been  shown  by  the . table 
on  pp.  81,  82.  In  fact,  in  the  majority  of  cases,  but 
four  teeth  have  previously  appeared  in  each  jaw, 
and  those  are  the  front  teeth.  With  the  commence- 
ment of  the  second  year,  the  first  grinding  teeth  are 
expected  to  begin  to  press,  not  next  to,  but  a little 
distance  from,  the  teeth  which  have  before  cut  their 
way  through.  Their  order  of  coming  and  progress 
is  irregular.  Between  the  fourteenth  and  twen 
tieth  months,  the  spaces  left  between  the  front  teeth 
and  the  grinders  will  begin  to  be  filled  up,  by  the 
stomach  and  eye  teeth  pushing  their  way  through. 
It  thus  happens  that  the  same  number  of  teeth  are 
to  be  expected  to  come  above  the  gum  during  the 


THE  SECOND  YEAR. 


99 


Their  treatment.  Weaning. 

second  year,  as  the  first ; but  they  are  larger,  make 
their  way  more  slowly,  and  are  attended  with  more 
disturbance  of  the  system  than  are  the  front  teeth. 
From  this  and  other  causes,  it  happens  that  the 
second  year  is  a period  of  great  peril  to  children, 
and  demands  from  the  parent  renewed  watchfulness 
and  care. 

The  general  rules  given  in  chapter  sixth,  for  the 
guidance  of  the  mother  during  the  teething  of  the 
child,  contain  all  that  needs  to  be  said  upon  the 
subject,  and  therefore  I need  not  repeat  them.  The 
mother  should  fix  them  in  her  memory,  and  govern 
herself  by  them. 

Of  Weaning, 

By  the  filling  of  the  jaw  with  teeth,  nature  seems 
to  intimate  that  the  child  is  now  prepared  for  a 
more  solid  diet  than  that  which  it  has  hitherto  had. 
The  change  from  milk  to  solid  food,  is  called  wean- 
ing, and  is  a very  grave  matter. 

The  time  at  which,  and  the  mode  in  which  the 
child  is  to  be  weaned,  depends  upon  circumstances. 
Of  these,  the  season  of  the  year  is  one  of  the  most 
important.  A child  that  may  properly  be  put  upon 
solid  diet  in  October,  could  not  be  so  in  June,  with 
out  running  the  greatest  risk  of  dying,  or  at  least  of 


100 


THE  SECOND  YEAE. 


Influence  of  change  of  diet , warm  weather , and  teething. 

being  dangerously  sick  in  July  and  August.  The 
causes  are  easily  discovered. 

The  change  from  milk  to  solid  food,  is  apt  to 
make  the  bowels  move  more  frequently,  just  as  a 
grown  person  who  changes  his  diet  from  substances 
like  the  finest  wheat  bread  to  coarse  meal  or  rye,  is 
apt  to  have  a looser  state  of  the  bowels  in  conse- 
quence. The  heat  of  Summer  seems  also  to  exert 
an  influence  which  we  cannot  explain,  but  the  result 
of  which  we  know  to  be,  that  the  bowels  are  more 
open.  I have  before  alluded  to  the  fact,  that  the 
pressure  of  the  teeth  against  the  gums  as  they  are 
making  their  way  through,  often  has  the  same  effect. 
Now  when  all  three  of  these  influences  (change  of 
diet,  warm  weather  and  teething)  are  combined,  it  is 
rarely  the  case  that  the  child  escapes  having  a 
severe  diarrhoea,  and  this  is  not  only  to  be  avoided 
on  its  own  account,  but  also  because  it  reduces  the 
child  to  that  condition  in  which  it  may  be  attacked 
by  cholera  infantum , one  of  the  gravest  diseases  of 
early  life.  It  is  because  these  influences  are  then 
combined,  that  nurses  have  learned  to  dread  for  a 
child  its  second  Summer , and  not  because  there  is  in 
that  period  itself  anything  dangerous.  If  a child 
is  born  in  September,  it  will  probably  be  cutting  its 


THE  SECOND  TEAR. 


101 


The  second  Summer.  When  critical.  When  not  to  wean  the  child. 

front  teeth  during  the  first  Summer,  while  it  may 
have  got  all  the  rest  before  July  of  its  second  Sum- 
mer. Under  such  circumstances,  it  is  the  first 
Summer  that  is  the  more  critical  period  ; but  from 
the  fact  that  the  child  is  then  nursing,  and  that  the 
teeth  which  are  coming  through  are  those  which 
give  the  least  trouble,  the  first  of  the  three  causes 
.of  irritation,  which  I have  before  enumerated,  does 
not  exist,  while  the  last  is  much  less  potent.  But  a 
child  that  is  fed  on  cow’s  milk  will  often  suffer 
excessively  from  this  combination  during  its  first 
Summer.  The  knowledge  of  these  facts  often 
removes  a load  of  anxiety  from  the  hearts  of 
mothers  whose  children  are  approaching  their 
second  warm  season. 

Rules  Concerning  Weaning. 

If  the  child  is  thriving,  gaining  rapidly  in 
strength,  and  contented  with  the  breast-milk,  it  will 
be  well  to  allow  him  to  continue  to  nurse  through 
his  second  Summer,  even  though  this  completes  his 
second  year.  This  presupposes  that  the  mother  is 
able  to  furnish  to  the  child  an  abundance  of  milk 
without  herself  being  reduced.  All  of  these 
conditions  are  rarely  found  combined ; very  few 


102 


THE  SECOND  YEAR. 


How  it  learns  to  tat.  The  child  may  be  delicate.  Insufficient  supply  of  milk. 

mothers  being  able  to  nurse  their  children  entirely 
after  they  are  nine  months  old.  This  period  has  in 
fact  been  recommended,  by  some  writers,  as  the 
proper  time  to  wean  the  child,  but  I am  sure  it  is 
often  too  soon.  Usually  the  child,  if  vigorous  and 
hearty,  has  learned  to  eat  solid  food,  as  bread, 
before  this  time,  and  is  by  no  means  contented  with 
less  substantial  diet.  When  this  is  the  case,  he  may 
be  indulged  in  some  of  those  articles  which  will  be 
mentioned  as  fitted  for  weaned  children.  The  selec- 
tion of  one  or  another  must  be  guided  by  his 
condition,  under  some  circumstances  that  being 
improper  which,  at  other  times,  would  be  the  most 
beneficial. 

When  the  child  has  shown  any  tendency  to  diar- 
rhoea, is  delicate  and  puny,  it  should  not  be  weaned 
till  after  its  second  Summer.  The  reason  is,  obvious- 
ly, that  it  is  not  fitted  to  bear  the  exposure  to  diarrhoea 
which  it  must  incur,  and  this  point  does  not  require 
to  be  dwelt  upon. 

When  the  mother  furnishes  but  a scanty,  or  at  any 
rate  an  insufficient  supply  of  milk  for  the  child, 
which  may  be  known  by  the  constant  hunger  of  the 
child  and  the  inability  of  the  mother  to  satisfy  him, 
he  may,  if  all  his  teeth  are  through  — eight  in  each 


THE  SECOND  YEAR. 


103 


Partial  weaning.  When  there  is  no  choice.  The  change  to  be  gradual. 

jaw  — be  either  entirely  or  partly  weaned,  though 
Summer  is  approaching.  If  his  teeth  are  not  all 
through,  he  should  be  partly  weaned,  unless  cool 
weather  is  approaching.  By  partial  weaning,  I 
mean  that  he  is  fed  in  part,  and  nursed  in  part. 
Thus,  he  may  be  allowed  to  nurse  two  or  three  times 
in  the  twenty-four  hours,  his  other  meals  being  of 
more  or  less  solid  food  and  milk.  The  reason  for 
giving  this  advice,  is  a simple  one.  By  this  method, 
if  the  heat  of  Summer  produces  a diarrhoea,  the 
child  can  be  at  once  confined  to  the  breast-milk,  and 
his  chances  of  recovery  are  much  greater,  while  the 
same  course  can  be  taken  if  the  teeth,  or  change  in 
diet,  produce  a similar  derangement. 

When  the  mother’s  milk  disagrees  with  the  child, 
as  it  sometimes  will,  there  of  course  remains  no 
choice,  except  between  weaning  and  providing  a 
wet  nurse.  Which  course  shall  be  taken  depends 
upon  the  age  of  the  child  and  the  season  of  the  year. 

Whatever  may  be  the  season,  unless  the  mother  is 
unable  to  do  so,  or  the  milk  is  hurtful  to  the  infant, 
it  is  better  to  make  the  change  from  nursing  to  feed- 
ing, a gradual,  rather  than  a sudden  one.  This  is 
better  for  both  the  mother  and  child.  It  should  be 
accustomed  to  nurse  for  a shorter  time,  as  well  as  at 


104 


THE  SECOND  YEAR. 


The  mother's  life  may  he  in  danger.  Of  nursing  vShile  menstruating. 

longer  intervals,  and  the  number  of  times  being 
reduced  to  one,  it  may  be  entirely  discontinued.  If 
there  is  any  trouble  in  making  the  child  give  up  nurs- 
ing, a little  finely  powdered  Peruvian  bark  or  myrrh, 
dusted  on  the  nipple  before  nursing,  will  give  him  a 
disgust  to  it  that  will  not  permit  him  to  take  it 
again. 

When  nursing  reduces  the  mother  to  such  a 
degree  as  to  endanger  her  life,  there  can  be  no 
doubt  that  she  is  justified  in  weaning  her  infant, 
even  if  she  cannot  get  a wet  nurse.  In  some  parts 
of  the  country,  a disease  popularly  known  as  nursing 
sore  mouth,  often  compels  the  physician  to  advise 
this  course. 

There  are  two  conditions  in  which  the  mother  is 
often  at  a loss  to  know  whether  or  not  she  should 
continue  to  nurse  her  child.  The  first  is  when  the 
menses  return — that  is  when  the  monthly  turns  reap- 
pear. When  this  is  the  case,  the  mother  should 
notice  whether  or  not,  at  that  period,  there  is  any 
tendency  to  colic  or  diarrhoea  in  the  child,  and  if  so, 
nurse  it  a little  less  frequently,  or  partly  feed  it 
for  a day  or  two.  But  generally  there  is  no  dis- 
turbance of  the  child’s  digestion  produced  by  the 
milk,  and  it  continues  to  thrive.  A recent  French 


THE  SECOND  YEAR. 


105 


Of  nursing  while  pregnant 


writer  states  that  his  observation  leads  him  to 
believe  that  the  menses  reappear  between  the  fifth 
and  seventh  months,  in  one-third  of  all  who  nurse. 
This  cause  does  not  interfere  with  nursing. 

The  other  condition  to  which  I alluded  is  preg- 
nancy. When  the  mother  finds  herself  in  this 
condition,  it  is  usually  necessary  for  her  to  wean  her 
child.  She  feels  the  exhaustion,  if  nursing,  and  can- 
not put  herself  in  the  most  favorable  condition  for 
the  healthy  growth  of  the  child  in  her  womb.  Still 
some  mothers  will  go  on  nursing  to  the  end  of  the 
sixth  month  of  their  pregnancy,  without  any  incon- 
venience. The  mother’s  milk  is  usually  altered  in 
its  ingredients  by  this  event,  and  does  not  agree 
with  the  child.  When  this  is  the  case,  it  must  be 
weaned.  My  usual  course  is  to  advise  the  mother  to 
wean  her  child,  even  if  the  milk  agrees  with  it, 
unless  hot  weather  is  just  at  hand,  so  that  there  is 
not  sufficient  time — say  two  months — to  accustom 
the  child  to  its  new  food  before  that  comes ; or, 
unless  it  is  probable  that  during  the  hot  weather  it 
will  be  cutting  several  teeth.  In  that  case  a partial 
weaning  may  take  place,  and  if  the  new  diet  proves 
injurious,  or  if,  from  any  cause,  diarrhoea  occurs,  the 
child  can  then  be  kept  on  the  breast  milk  entirely. 


106 


THE  SECOND  TEAR. 


How  to  wean  a child. 

Unless  it  should  be  absolutely  necessary,  from  the 
disappearance  of  the  mother’s  milk,  or  from  its  pro- 
ducing diarrhoea  and  colics,  weaning  during  the  hot 
weather  of  July  and  August  should  not  be  attempt- 
ed. It  would  be  better  to  obtain  a wet  nurse  for 
these  months  only,  than  to  endanger  the  life  of  the 
child  by  an  abrupt  and  entire  change  of  diet. 

Manner  of  Weaning . 

Ordinarily  about  the  commencement  of  the  second 
year,  the  infant  is  allowed  to  eat  a little  bread  or 
cracker,  and  when  no  green  discharges  from'  the 
bowels  or  colicky  pains  intimate  that  it  is  injurious, 
the  practice  can  be  continued.  As  the  child  grows 
older,  the  boundaries  of  its  diet  may  be  gradually 
increased,  care  being  taken  to  observe  its  effects. 
Any  article  found  to  be  indigestible  or  digested  with 
difficulty,  should  be  at  once  discarded,  whatever 
may  be  the  previous  notions  concerning  its  good 
effects.  It  is  true  of  children,  as  of  adults,  that,  as 
the  proverb  has  it,  “What  is  one  man’s  meat  is 
another  man’s  poison,”  and  to  compel  one  to  eat  a 
certain  article  of  food  because  it  agreed  with 
another,  is  only  to  run  the  risk  of  making  it  sick. 
Herein  consists  the  great  art  of  feeding  children, 


THE  SECOND  YEAR. 


107 


Articles  that  may  he  used.  How  to  cook  meats. 

and  it  is  with  reference  to  this  fact  that  my  remarks 
on  diet  are  made. 

The  articles  of  diet  to  which  the  child  may  be 
gradually  accustomed  by  the  close  of  the  second 
year,  are,  (beside  milk),  bread,  potatoes,  both  white 
and  sweet  varieties  ; butter,  which  must  be  entirely 
sweet  and  not  very  salt ; rice,  soft  boiled  eggs,  if 
entirely  fresh,  or  the  yolks  of  eggs  boiled  till  they 
are  rather  hard ; simple  broths,  and  plain  roasted 
or  boiled  meats.  Oysters  are  more  easily  digested 
than  meats,  but  all  children  do  not  like  them, — yet 
when  relished  they  are  very  acceptable.  It  should 
be  remembered,  however,  that  they  have  some  ten- 
dency to  open  the  bowels,  and  their  effects  in  this 
respect  should  be  noted,  as  indeed  should  be  done 
with  all  new  articles  of  food.  Boiled  meats  are  not 
so  good  for  them  as  roasted, — the  former  containing 
much  less  of  the  nutrient  materials  than  the  latter, 
or  at  least,  in  a less  desirable  condition.  Broiled 
meats  are  also  good,  but  fried  are  to  be  avoided. 
Fish  is  to  be  shunned,  as  are  salted  meats.  Baked 
potatoes  seem  to  be  much  better  for  children  than 
boiled,  and  sweet — or  as  they  are  sometimes  called, 
Carolina  potatoes — are  more  readily  digested  than 
the  common  white  potato.  In  fact,  I frequently 


108 


THE  SECOND  YEAR. 


Potatoes.  The  juice  of  meat  to  he  first  given.  Variety  in  diet. 

order  the  former  after  a diarrhoea,  having  found  it 
useful,  and  I learn  that  it  is  used  in  the  same  way  in 
the  Southern  States.  Whichever  is  used,  it  should  be 
thoroughly  baked  or  roasted,  the  skin  taken  off,  and 
a little  milk,  cream,  or  butter  may  be  put  on  it  after 
it  is  mashed.  Meats  should  not  be  done  very  hard. 
They  should  be  thoroughly  cooked,  but  not  exces- 
sively so.  A beefsteak  that  is  still  red  in  the  inside 
when  cut,  has  far  more  nourishment  in  it  than  one 
that  is  brown  throughout. 

At  first  the  child  should  be  allowed  to  suck  the* 
meat  only,  so  as  to  obtain  the  juices,  but  as  the 
experiment  proves  successful,  it  may  be  allowed 
what  it  will  try  to  get,  namely,  the  meat  itself. 
This  should  be  cut  very  fine,  and  given  to  it  in 
small  pieces,  and  not  entirely  alone.  It  should  be 
accompanied  with  bread,  or  potato,  or  rice,  or  some 
other  starchy  food. 

Children  do  not  like  to  be  constantly  kept  on  just 
the  same  routine  of  diet  any  better  than  adults. 
Their  meals  should  be  varied,  so  that  breakfast  shall 
be  different  from  dinner,  and  lunch  from  supper,  and 
the  routine  of  different  days  should  vary.  Milk  is 
the  only  article  that  does  not  seem  to  pall  upon  the 
appetite,  though  I have  known  one  of  my  own  chil- 


THE  SECOND  YEAR. 


109 


Fruits  injurious.  Drinks. 

dren  to  eat  fried  rice  every  morning  for  a year,  and 
then  be  disappointed  because  it  did  not  appear. 

It  will  be  observed,  that  I have  not  included 
fruits  in  this  diet  table.  They  are  almost  univer 
sally  injurious  previous  to  the  close  of  this  year,  and 
should  be  avoided.  In  Winter,  when  there  is  much 
constipation,  a little  baked  sweet  apple,  or  stewed 
prunes,  may  be  cautiously  given  to  remove  this  con- 
dition, but  this  needs  to  be  done  cautiously.  Straw- 
berries, blackberries,  raspberries,  in  fact,  all  kinds  of 
berries  are  objectionable  on  account  of  the  seeds 
they  contain,  or  the  skin  that  envelopes  them ; 
while  the  larger  and  more  solid  fruits  are  equally 
bad,  unless  they  are  cooked,  and  even  then  they  must 
be  used  cautiously. 

For  drink,  the  child  may  have  milk,  or  a mixture 
of  milk  and  water,  and  sugar.  Tea  and  coffee  are 
injurious.  Cold  water  should  be  given  in  modera- 
tion, and  it  is  better  to  sweeten  it  sometimes, 
particularly  in  Summer,  using  of  course  refined 
sugar.  This  eau  sucree  does  not  seem  to  have  so 
unpleasant  an  effect  in  hot  weather  as  simple  water, 
and  is  usually  very  much  liked. 

Children  must  be  at  once  taught  that  they  will 
not  get  that  which  is  eaten  by  others,  even  if  they  do 


110 


THE  SECOND  YEAR. 


The  necessity  of  controlling  children  in  their  diet. 

cry  for  it.  From  neglect  of  tliis  rule,  they  are  often 
exposed  to  great  danger,  if  not  in  fact  killed.  At 
the.  Demilt  Dispensary,  my  constant  question  to 
mothers,  who  bring  in  children  with  diarrhoeas,  is. 
“ What  do  you  feed  the  child  with  ? ” and  the  com- 
mon answer  is,  “ 0 ! pretty  much  everything  that  is 
going.”  Meats  salt  and  fresh,  especially  the  former, 
half  boiled  potatoes,  fruit,  cabbage  even,  with  tea 
and  coffee  for  drink,  not  uncommonly  make  up  their 
diet  before  they  are  two  years  old,  and  they  are  sure 
to  be  “ uncommon  fond  ” of  just  that  thing  that  is 
worst  for  them.  I know  these  patients  are  from  the 
lower  classes,  but  I could  give  instances  of  similar 
errors  in  intelligent  families.  The  fact  is,  these 
little  children  soon  learn  that  if  they  want  a thing 
they  have  only  to  reach  out  their  hands  and  cry,  to 
get  it,  and  they  will  cry  for  everything  they  see, — 
while  they  as  quickly  learn  that  it  is  of  no  use  cry- 
ing, and  are  therefore  perfectly  contented  when 
denied  what  they  ask  for.  It  cannot  be  too  often 
repeated,  in  this  respect,  as  well  as  all  others,  that 
the  mother  must  rule  her  child,  or  the  child  will  rule 
her,  and  children  are  the  most  inexorable  tyrants. 


THE  SECOND  YEAR. 


Ill 


Dress . Fashionable  dress  sometimes  dangerous. 


The  Dress, 

The  dress  must  be  regulated  by  the  season,  the 
climate,  and  the  vigor  of  the  child.  Common  sense, 
not  fashion,  should  rule  here.  Insufficient  clothing 
exposes  the  child  to  contract  colds  and  diarrhoeas, 
while  excessive  clothing  is  also  to  be  shunned.  As  I 
have  before  said,  no  exact  dress  can  be  described 
which  shall  be  adapted  to  all  the  varieties  of 
climate  found  between  Maine  and  Louisiana,  for 
those  who  live  in  houses  warmed  throughout,  and 
those  who  live  where  only  one  or  two  rooms  are 
warmed.  But  the  rule  to  dress  the  child  so  that  it  is 
comfortable,  and  meet  every  change,  as  in  going  out 
of  doors,  with  a corresponding  increase  of  clothing, 
surely  can  be  borne  in  mind,  and  will  be  useful. 

Children  have  a much  larger  proportional  surface 
exposed  to  the  air,  than  do  adults,  and  for  this  rea- 
son they  do  not  so  well  bear  exposure  to  cold.  How 
great,  then,  is  the  cruelty  as  well  as  folly  of  sending 
them  out  of  doors  in  Winter  with  garments,  how- 
ever richly  wrought,  that  leave  half  their  arms 
exposed — that  come  up  only  to  their  collar  bones, 
and  scarcely  down  to  their  knees.  The  children  of 
the  rich  are  apt  to  suffer  in  this  way  rather  than 


112 


THE  SECOND  YEAR. 


Adaptation  of  dress  to  changes. 

5 

those  of  the  poor.  I have  frequently  seen  a mother 
wrapped  in  -silks  and  shawls  and  furs,  leading  her 
child  dressed  at  an  enormous  expense,  but  so  expos- 
ed as  to  be  almost  purple  with  cold.  Bronchitis 
is  the  very  frequent  result  of  this  practice, 
and  when  repeated,  consumption  may  follow. 
During  cold  weather  let  the  overcoat  come  up  close 
in  the  neck,  and  be  aided  by  a fur  or  other  warm 
tippet.  Let  the  sleeves  be  sufficiently  long  to  come 
to  the  wrist,  close  enough  to  keep  out  the  cold,  and 
let  additional  coverings  be  put  on  the  legs. 

Children  should  be  dressed  warmer  when  they 
are  to  ride  out  than  when  they  are  to  walk.  The 
exercise  of  walking  keeps  their  blood  in  more  active 
circulation,  so  that  they  do  not  as  readily  become 
cold.  When  sudden  and  great  changes  in  the  tem- 
perature of  the  air  occur,  the  dress  of  children 
should  be  at  once  arranged  so  as  to  meet  it,  unless 
in  a room  with  a fire  in  it,  which  of  course  lessens  the 
change,  in  fact  counteracts  it.  But  many  of  these 
changes  occur  during  the  Summer,  and  should  be 
carefully  noted,  and  pains  taken  to  ward  off  their 
effects.  A little  care  will  save  weeks  of  sickness, 
and  give  the  child  a vigorous  instead  of  a feeble 
constitution. 


THE  SECOND  YEAR. 


113 


The  bed  in  Summer  and  Winter. 


Importance  of  fresh  air. 


The  Bed. — Ventilation  of  the  Sleeping  Room . 

The  bed  of  the  child  should  continue  to  be  soft 
enough  not  to  trouble  it  by  its  hard  pressure,  and 
so  hard  that  it  will  not  sink  into,  and  thus  become 
too  warm.  A thin  feather  bed  is  desirable  during 
cool  weather,  and  during  the  w&rm  a mattrass  cov- 
ered with  a quilt  or  some  other  slightly  soft  material.. 
The  coverings  should  be  light,  but  varied  as  to 
degree,  according  to  the  climate  and  season.  In  the 
hottest  weather  a sheet  is  all  that  is  borne,  but 
during  cold  weather  blankets  and  other  warm  cov- 
erings should  be  added,  so  as  to  keep  the  child 
warm,  but  not  so  as  to  throw  it  constantly  into  a 
profuse  perspiration.  These  require  to  be  tucked  in 
pretty  carefully  to  prevent  the  child  from  kicking 
them  off,  and  thus  exposing  itself  to  be  chilled. 

The  ventilation  of  the  sleeping  apartment  should 
be  carefully  attended  to,  and  it  should  not  only  be 
aired  during  the  day,  but  at  night  there  should  be  a 
provision  made  for  fresh  air.  The  smaller  the  bed- 
room, the  more  imperative  is  this.  During  the 
whole  year,  except  the  Winter,  the  windows  should 
be  let  down  at  the  top  to  a greater  or  less  distance, 
and  during  the  hottest  weather  they  may  be  wide 
8 


114 


THE  SECOND  YEAR. 


Fires  in  the  sleeping  room. 

open,  unless  it  be  in  those  districts  of  our  Southern 
States  in  which  the  night  air  is  so  loaded  with  mala- 
ria as  to  be  injurious  on  that  account.  The  good 
effect  of  this  ventilation  can  often  be  seen  when 
a child  is  restless  in  his  sleep,  tossing  from  side  to 
side,  without  there  being  any  evidence  of  his 
being  ill.  Opening  the  window  will  frequently  at 
such  times  soothe  the  child,  and  his  rest  will 
become  tranquil  and  refreshing.  Adults  are  sensitive 
to  such  influences,  but  not  to  the  extent  that  chil- 
dren are.  Pure  air,  by  day  and  by  night,  should  be 
as  carefully  provided  for  them  as  food.  From  want 
of  it,  ill  health  results  in  many  cases. 

When  a fire  is  kept  in  the  sleeping  room  during 
the  night,  it  becomes  still  more  important  to  provide 
carefully  for  a renewal  of  pure  air.  The  fire  has  an 
effect  upon  the  air  similar  to  that  which  is  produced 
by  persons  breathing  it,  so  that  a given  quantity  of 
it  becomes  much  more  quickly  unfit  for  use.  Unless 
then,  a full  supply  of  fresh  air  is  provided,  all  who 
occupy  the  room  will  be  subject  to  these  injurious 
influences,  and  children  feel  them  first.  The  dis- 
turbed sleep,  restless  tossing,  and  mutterings,  give 
evidence  of  the  effect  of  bad  air,  which  is  confirmed 
by  the  sunken  eyes,  dull  headache,  and  unrefreshed 
feeling,  which  remains  in  the  morning. 


THE  SECOND  YEAR. 


115 


Opening  the  windows.  Precocious  children. 

It  is  necessary  that  the  child’s  bed  should  be  so 
eituated  that  it  is  sheltered  from  currents  of  air 
from  the  open  doors  or  windows,  but  aside  from  this, 
no  additional  precautions  are  necessary.  The  habit 
of  opening  the  windows,  commenced  during  warm 
weather,  can  be  continued  till  cold  weather  comes. 
If  the  child  lies  quietly,  not  throwing  the  clothing 
off  during  his  sleep,  it  is  of  little  consequence  .how 
cool  the  air  of  the  room  is,  provided  he  is  sufficiently 
covered  to  be  warm.  If  sufficient  care  is  taken  that 
fresh  air  is  supplied  in  abundance, — not  after  having 
passed  over  the  red  hot  iron  of  a furnace,  but 
directly  from  out  of  doors, — much  less  injury  results 
from  sleeping  in  warm  rooms,  though  there  is,  I 
think,  not  quite  that  degree  of  invigoration  which  is 
felt  when  the  room  is  cool. 

Of  Education . 

It  is  not  well  at  this  age  to  stimulate  too  much 
the  faculties  of  the  child  in  anyway.  A profes^ 
sional  friend  is  accustomed  to  say,  that  till  a child  is 
three  years  old,  the  more  it  is  treated  like  a cabbage 
that  is  growing  the  better.  This  vegetable  has  some- 
how come  to  be  used  as  an  emblem  of  dulness,  and 
his  meaning  is,  that  it  is  better,  before  that  period, 


116 


THE  SECOND  YEAR. 


Of  teaching  a child  too  much . Its  perils . 

to  be  chiefly  intent  upon  strengthening  the  frame, 
rather  than  stimulating  the  mind.  It  is  very  pleas- 
ant to  see  children  bright  and  learning  rapidly,  but 
this  is  too  often  accompanied  with  a state  of  the 
nervous  system  that  is  anything  but  desirable.  Till 
the  close  of  the  second  year  at  least,  no  especial 
pains  should  be  taken  to  teach  the  child  rapidly, 
either  to  walk  or  talk.  The  first  children  in  a 
family  are  most  apt  to  be  injured  by  this  course, 
their  parents  being  anxious  to  witness  their  progress, 
and  impatient  of  having  their  child,  which  to  them 
is  a prodigy,  backward  in  learning.  It  is  urged  to 
talk,  and  as  it  progresses  in  its  command  of  lan- 
guage, its  mind  is  kept  constantly  excited  by  stories, 
by  pictures,  and  by  learning  to  read,  together  with 
all  the  little  accomplishments  which  are  so  charm- 
ing in  children.  Yet  I never  can  look  upon  these 
very  forward  ones  without  a sigh,  when  I think  of 
the  increased  perils  which  they  incur  on  this  account. 
Their  over  excitement  of  the  nervous  system  tells 
upon  the  rest  of  the  body,  and  increases  the  risk  of 
convulsions,  or  of  water  on  the  brain.  Neither 
should  parents  absolutely  refrain  from  teaching  them 
anything.  They  will  soon  enough  try  to  imitate 
words  and  sentences,  and  while  this  imitation  may 


/ 


THE  SECOND  YEAR. 


117 


Creeping  and  walking. 

be  gently  encouraged,  it  should  not  be  stimulated. 
Let  the  parents  rather  check  the  eager  curiosity  of 
the  child  to  learn,  especially  if  he  be  at  all  preco- 
cious, than  urge  it  on ; and  turn  their  attention  to 
giving  him  a sound  body,  well  assured  that  the  sub- 
sequent mental  training  will  be  more  useful,  more 
desirable,  and  more  complete. 

Of  Creeping  and  Walking. 

The  objection  to  teaching  a child  to  walk  too 
soon,  is  that  there  is  some  danger  of  deformity 
resulting.  A child  that  creeps,  soon  learns,  when 
strong  enough,  to  raise  himself  on  his  knees  and 
feet,  and  can  then  be  aided  in  learning  the  art 
of  walking.  Sometimes,  however,  nurses  hold  their 
children  too  constantly,  for  fear  they  will  soil  their 
frocks.  They  should  be  allowed  to  roll  round  on  the 
floor,  that  they  may  learn  to  creep  ; they  should  be 
allowed  to  creep  that  they  may  learn  to  walk,  and 
thus  their  muscular  strength  anticipates  the  efforts 
which  call  for  its  use.  In  the  care  of  children,  it  is 
in  general  a wise  maxim  to  follow  nature,  and  not  to 
attempt  to  lead  her. 


118 


FROM  THE  SECOND 


The  last  of  the  milk  teeth. 


Chapter  VIII. 

FROM  THE  SECOND  TO  THE  SIXTH  YEAR. 

The  last  period  of  early  life  of  which  I propose 
to  treat  is  from  the  second  year  to  the  sixth,  this 
being  the  time  at  which  the  peculiar  dangers  of 
infancy  and  early  childhood  are  passed,  and  the 
mother  has  by  this  time  become  familiar  with  the 
best  mode  of  taking  care  of  her  child. 

Of  the  Teeth . 

It  will  be  remembered  that  it  was  stated  that 
the  back  teeth  (posterior  molars)  of  the  first  set, 
one  on  each  side  of  each  jaw,  may  make  their 
appearance  at  any  time  from  the  eighteenth  to  the 
thirty-sixth  month.  It  is  rare  that  they  come  before 
the  close  of  the  second  year.  Their  order  is  irreg 
ular,  as  well  as  the  time.  When  they  appear  very 


TO  THE  SIXTH  YEAR. 


119 


General  directions.  Keeping  the  teeth  clean. 

early,  they  add  to  the  general  disturbance  produced 
by  the  growth  of  the  stomach  and  eye  teeth,  and 
increase  the  dangers  of  this  period.  When  they 
appear  later,  they  do  not  usually  produce  much  dis- 
turbance. The  child  has  at  that  time  learned  to 
express  his  sensations  by  language,  instead  of  signs  dif- 
ficult of  interpretation,  so  that  the  pain  in  his  mouth, 
if  there  be  any,  leads  him  to  desire  his  mother  to 
look  at  the  place.  Such  requests  should  not  be  neg- 
lected, and  if  the  gum  is  found  to  be  raised  by  the 
tooth  pressing  beneath,  it  should  be  freely  divided, 
as  has  been  before  directed.  One  who  remembers 
the  annoying  irritation  produced  by  the  sharp  cor- 
ners of  the  wisdom  teeth  before  they  have  come 
through,  and  the  relief  that  cutting  the  gum  gives, 
cannot  wonder  that  children  suffer  exceedingly 
from  the  same  cause,  or  hesitate  to  relieve  them. 

Great  care  should  be  taken  of  the  teeth  to  keep 
them  free  from  the  accumulations  which  sometimes 
form  upon  them  and  hasten  their  destruction.-  From 
neglect  of  such  precautions,  the  front  teeth  begin  to 
decay  before  the  back  teeth  are  fairly  through,  and 
the  first  set  of  teeth  are  all  gone  a year  or  two 
before  the  second  set  begin  to  come.  I have  seen 
them  destroyed  much  earlier.  In  one  case  the  front 


120 


FROM  THE  SECOND 


Tooth  powders.  Diet. 

teeth  had  gone  before  the  stomach  and  eye  teeth 
came  through.  The  necessity  of  having  food  well 
chewed  before  it  is  swallowed,  should  prevent  our 
neglecting  any  mode  of  keeping  the  first  teeth  from 
destruction  till  their  substitutes  are  ready  to  take 
their  place.  For  this  reason,  the  teeth  should  be 
rubbed  at  least  once  every  day  with  a soft  tooth 
brush  or  a bit  of  linen  folded  in  two  or  three  thick- 
nesses over  the  finger.  Wetting  with  simple  water 
is  usually  enough,  but  sometimes  tooth  powders  are 
desirable,  though  of  these  only  the  finest  should  be 
used.  Peruvian  bark  very  finely  powdered  is,  I 
think,  one  of  the  best  things  to  use.  It  does  not 
scratch  the  enamel  as  those  powders  do  which  con- 
tain chalk,  and  is  very  good  for  the  gums.  The 
objection  to  it  is  its  bitter  taste,  which  children 
dislike.  Orris  root,  also  finely  powdered,  is  what  I 
use  when  the  Peruvian  bark  is  objected  to.  Only  a 
small  quantity  of  either  should  be  used,  and  that 
only  occasionally — rarely  oftener  than  once  a week. 

Diet. 

The  diet  of  the  child  continues  to  be  a matter  of 
great  importance.  The  mother  should  keep  a com 
stant  oversight  of  it,  and  immediately  put  a stop  to 


TO  THE  SIXTH  YEAR. 


121 


Varieties  of  food  that  may  It  used. 

the  use  of  any  article  that  is  found  to  be  injurious. 
Following  the  course  pointed  out  as  adapted  to  the 
latter  part  of  the  second  year,  very  careful  experi- 
ments can  be  made  with  other  articles  of  food.  The 
rule  should  be  scrupulously  adhered  to,  that  only  the 
simplest  and  most  easily  digested  food  is  to  be  used. 
Spiced  dishes ; those  which  are  commonly  called 
very  rich,  that  is,  in  which  there  is  a great  dea'l  of 
butter  or  fatty  substance  ; pickles  of  all  sorts  ; most 
fruits  preserved  in  thick  syrup, — all  this  class  of 
substances  are  to  be  almost  absolutely  forbidden. 
Milk  may  still  be  freely  allowed,  and  should  consti- 
tute a large  part  of  at  least  one  meal  every  day. 
The  ordinary  simple  vegetables  may  generally  be 
used  if  cooked,  except  green  corn  and  beans, 
whether  green  or  dry.  The  vegetables  which  are 
eaten  uncooked  should  be  forbidden,  as  they  are, 
without  exception,  difficult  of  digestion.  Most  nuts 
and  dried  fruits  are  injurious,  though  boiled  chestnuts 
may  be  occasionally  given  as  a great  treat.  Sugar* 
is  often  blamed  for  much  that  it  does  not  do.  When 
given  at  meal-times,  and  in  moderate  quantities,  I do 
not  remember  to  have  seen  it  do  any  harm.  Can- 
dies, however,  I do  not  include  in  this  remark. 
These  are  often  injurious  from  the  effects  of  other 


122 


FROM  THE  SECOND 


Gandies  and  sugar.  When  they  may  be  used  and  when  not. 

ingredients  than  the  sugar.  Those  which  are  paint- 
ed are  especially  to  be  avoided,  the  paint  often 
containing  very  poisonous  compounds  of  lead,  arse- 
nic, and  other  metals.  Those  which  are  highly 
flavored,  as  with  peppermint,  sassafras,  &c.,  contain 
more  or  less  of  volatile  oil,  on  which  their  flavor 
depends,  and  these  are  too  stimulating  to  the 
stomach  to  be  often  used.  But  another  very  great 
objection  to  candies  arises  from  the  fact  that  they 
are  given  usually  between  meals,  and  the  process  of 
digestion  is  interfered  with.  It  is  necessary  that, 
the  stomach  should  rest  between  meals.  After  a 
certain  amount  of  food  has  been  taken  into  it,  diges- 
tion commences,  and  if  no  more  than  proper  is 
eaten,  or  it  be  not  too  unmanageable,  it  is  all  dis- 
solved and  passed  into  the  intestines.  After  the 
stomach  has  thus  disposed  of  a meal,  it  ought  to 
have  time  to  rest,  for  it  is  no  more  possible  for  the 
stomach  to  keep  digesting  all  the  time,  than  it  is  for 
the  legs  to  keep  walking  all  the  time.  If  it  is 
attempted  to  make  it  do  so,  it  becomes  exhausted 
and  weakened,  and  then  cannot  digest  even  proper 
quantities  of  simple  food.  This  produces  what  is  gen- 
erally known  as  dyspepsia,  and  is  attended  by  sour 
stomach  and  many  other  inconveniences.  The  rule 


TO  THE  SIXTH  YEAR. 


123 


Regularity  vn  meals.  Eating  between  meals. 

then,  should  be,  that  children,  as  well  as  grown  peo- 
ple, should  have  regular  hours  for  their  meals,  and  not 
be  allowed  to  eat  between  them.  They  will  usually 
be  willing  to  go  three  or  four  hours,  and  they  can  be 
allowed  to  eat  oftener  than  adults,  provided  it  is  at 
regular  times.  A regular  luncheon  may  be  put  in 
between  the  meals  of  the  family,  which  are  farthest 
apart — but  this  should  be  at  as  regular  an  hour  as 
dinner  — and  consist  of  simple  bread  and  butter, 
with  water  or  milk,  so  that  the  child  may  not  be 
tempted  to  eat  too  much.  One  can  now  understand 
how  candy,  given  as  it  ordinarily  is,  in  violation  of 
all  these  rules,  and  disregard  of  all  these  principles, 
must  be  injurious.  The  destruction  of  the  teeth 
which  is  usually  attributed  to  it,  arises  indirectly, 
and  not  from  the  immediate  effect  of  the  candy  upon 
them.  The  impaired  nutrition,  the  acidity  of  the 
stomach,  both  affect  the  teeth  and  serve  to  destroy 
them.  These  should,  therefore,  be  given  about  meal 
time,  and  in  very  moderate  quantities,  those  varieties 
being  selected  which  have  the  blandest  taste,  and 
come  the  nearest  to  pure  sugar.  It  may  also  be 
well  for  the  mother  to  remember  that  a child  that 
is  accustomed  to  receive  at  once  a pound  of  bon  bons , 
is  no  better  satisfied  with  the  pound,  than  is  one  not 


124 


FROM  THE  SECOND 


Cleanliness.  Fashion  again  illustrated. 

accustomed  to  that  quantity,  with  only  two  or  three 
— but  his  stomach  and  digestive  powers  are  injured 
much  more. 

The  Toilet. 

The  toilet  of  the  child  should  be  carefully 
attended  to.  By  this,  I do  not  mean  simply  its  hair, 
but  all  that  pertains  to  its  personal  habits.  Clean- 
liness is  one  of  the  cardinal  virtues,  and  should  be 
especially  instilled  into  the  young  mind.  A daily 
bath  it  should  be  taught  to  consider  a necessity,  and 
as  early  as  may  be,  it  should  learn  how,  not  only  to 
wash  its  face  and  hands,  but  to  sponge  all  of  its 
body.  The  habit  thus  early  formed,  will  not  be 
readily  abandoned,  and  will  conduce  very  much  to 
comfort  and  invigoration  during  adult  life.  The 
least  that  should  be  done  is  insisting  upon  a 
thorough,  washing  once  a week  all  the  year  round. 
This  should  not  be  inflicted  as  a sort  of  punishment, 
but  it  should  be  looked  forward  to  as  a pleasure. 

The  Dress . 

The  dress  of  the  child  should  continue  to  be 
adapted  to  the  climate  and  the  season,  and  to 'be 
guided  by  the  common  sense  principles  which  I 
have  before  pointed  out.  I have  not  unfre- 


TO  THE  SIXTH  YEAR. 


125 


The  poor  child  often  to  be  envied  by  the  rich. 


quently  seen,  during  Winter,  boys  in  the  street 
with  sacks  of  elegant  materials,  trimmed  with  lace, 
exposing  the  whole  upper  part  of  their  chests  and 
leaving  the  arms  bare  below  the  elbows  (though  the 
hands  are  carefully  gloved),  while  the  legs  are 
bare  from  a little  above  the  knee  half  way  to  the 
foot,  which  is  covered  with  a light  shoe  and  thin 
stocking.  The  arms  and  necks  of  their  sisters 
are  equally  unprotected,  though  fashion  fortunately 
allows  them  to  wear  longer  stockings.  But  their 
dresses  are  short  and  stand  out  (aided  at  present  by 
substantial  hoops)  in  such  a way  that  their  bodies  are 
almost  entirely  unprotected  from  their  waist  down. 
Their  pinched  features,  blue  lips,  and  shiverings  tes- 
tify to  their  sufferings,  although  they  look  as  if 
they  had  just  stepped  out  of  the  last  Paris  fashion 
plate,  and  their  parents  are  sure  that  they  are 
“ comme  il  faut”  They  have  good  reason  to  envy 
the  little  fellow  who  trudges  by  well  wrapped  in  a 
good  warm  coat,  though  it  comes  down  to  his  heels. 
It  may  be  well  enough  for  stout  highlanders  to  have 
their  legs  bare  in  Winter,  though  they  are  not  over 
fond  of  it ; but  a child  cannot  endure  it.  If  a 
mother  were  anxious  that  her  child  should  have  the 
bronchitis,  or  lung  fever,  or  croup,  I could  not  point 


126 


FROM  THE  SECOND 


The  night  dress.  Physical  education  most  important. 

out  a more  certain  way  to  contract  one  of  them,  than 
to  leave  the  body  thus  exposed,  and  it  is  only  a won- 
der that  any  survive  it.  Almost  every  physician  called 
to  treat  these  children  for  colds,  knows  how  difficult  it 
is  to  cure  them,  if  indeed  it  is  not  impossible,  unless 
a more  rational  dress  is  adopted.  Even  in  the  house 
it  is  dangerous,  for  children  will  run  to  the  door  or 
to  an  open  window,  and  the  danger  is  incurred 
before  one  can  stop  them. 

Concerning  their  night  dress  I do  not  need  to  add 
anything  to  what  has  been  said,  unless  it  be  to  sug- 
gest that  if  the  child  should  be  in  the  habit  of 
constantly  kicking  off  the  coverings,  it  is  well  to 
substitute  for  the  ordinary  night  gown  a garment  for 
which  I know  no  name,  but  which  is  like  a pair  of 
pantaloons  united  to  an  ordinary  waist  and  coming 
up  so  as  to  button  close  in  the  neck.  It  can  open 
either  behind  or  in  front,  and  has  the  advantage  for 
the  child,  that  if  it  does  kick  off  the  coverings  it  is 
not  entirely  exposed.  The  thickness  of  the  material 
of  which  it  is  made  should  vary  with  the  season. 

Education . 

The  physical  cultivation  should  be  considered  as 
paramount  to  intellectual  culture,  throughout  this 


TO  THE  SIXTH  YEAR. 


127 


Moderate  menial  culture.  Neglect  culpable. 

period,  and  even  later.  It  is  of  little  consequence 
to  a man  that  he  was  able  to  read  and  write,  and  to 
perform  other  prodigies  of  learning  before  he  was 
four  years  old  ; but  it  is  of  great  consequence  to 
him  that  during  that  time,  the  basis  of  a sound  consti- 
tution was  laid,  to  enable  him  to  meet  with  success  the 
wear  and  tear  of  life.  For  this  reason,  something 
of  the  “ cabbage  method  ” should  still  be  pursued, 
the  mind  of  the  child  being  sufficiently  occupied 
with  the  thousand  and  one  things  that  interest  child- 
hood, but  not  subjected  to  hot-house  forcing.  His 
mind  does  not  need  to  run  to  waste.  He  will 
think,  and  he  will  learn,  and  his  thoughts  and 
learning  should  be  guided  by  his  parents.  His 
habits  should  be  attended  to,  that  he  may  early  learn 
to  be  neat,  regular,  respectful,  and  obedient.  But  it 
is  not  necessary  to  shut  him  for  hours  in  hot  school* 
rooms,  toiling  over  his  books.  Very  great  wisdom 
is  requisite,  to  guide  a child  at  this  period,  and  it  is 
upon  the  mother  that  this  charge  chiefly  comes. 
Fortunately,  mothers  are  often  equal  to  the  task,  but 
to  too  many  it  becomes  soon  irksome,  and  they 
weary  of  the  constant  repetition  of  the  “ little  upon 
little  ” which  moulds  the  young  mind.  The  mother 
should  remember,  however,  that  whether  she  works  or 


128 


FROM  THE  SECOND  YEAR. 


Moral  influence  of  the  mother. 

rests,  influences  all  about  the  child,  are  making  their 
impressions  upon  it,  and  these  soon  cannot  be  effaced. 
Neglect,  tnen,  is  as  injurious  and  as  reprehensible  as 
actual  bad  influence,  for  it  leaves  open  the  way  for 
such  influences,  instead  of  closing  it  against  them. 

It  is  not  only  mentally,  but  morally,  that  the 
young  mind  is  exceedingly  impressible.  The  child 
can  be  early  taught  to  endeavor  to  do  right,  and  all 
the  fundamental  religious  principles  may  be  impress- 
ed upon  it  j not  in  grave  theological  disputations,  but 
in  the  simple  faith  to  which  in  its  highest  develop- 
ment we  give  as  the  greatest  praise,  the  epithet 
child-like.  The  instructions  of  early  childhood 
linger  in  the  memory  when  all  later  impressions 
have  faded  out,  and  the  prayers  learned  while  kneel- 
ing beside  his  mother,  have  often  been  the  only 
language  in  which  the  aged  sinner  could  express  his 
penitence.  I may  not  dwell  upon  this  topic,  but 
urge  mothers  to  remember,  that  their  children  are 
training  for  Eternity. 


OP  SICK  CHILDREN. 


129 


The  mother  not  to  be  the  doctor. 


Chapter  IX. 

OP  SICK  CHILDREN. 

It  is  not  my  purpose,  in  what  will  be  said  con- 
cerning the  care  of  sick  children,  to  attempt  to  give 
such  an  amount  of  information  to  the  mother  as  will 
enable  her  to  do  without  the  services  of  a physician ; 
and  I state  this  at  first,  and  distinctly,  so  that  no 
one  may  misapprehend  me.  My  reason  is,  not  that 
some  brother  practitioner  may  find  employment, 
but  simply  because  it  is  impossible,  in  the  limits  of 
this  or  of  any  other  one  book,  to  convey  so  much 
information  as  will  make  mothers  skilful  physicians. 
Medicine,  as  a science  or  an  art,  requires  long  years 
of  study  before  one  is  fitted  to  practice  it,  and  even 
then  the  new  fledged  doctor  is  not  trusted  very 
implicitly.  I should,  therefore,  be  most  unjust  to  the 
mother,  and  most  unjust  to  the  child,  if  I led  her, 
9 


130 


OF  SICK  CHILDREN. 


Poor  economy.  Physicians’  cmiaren. 

either  directly  or  indirectly,  to  suppose  that  she  was 
qualified  to  treat  disease  • to  rely  too  much  upon  her 
own  judgment.  A person  who  will  lavish  thousands 
of  dollars  on  dress,  or  gaiety,  or  show,  and  yet  let 
the  disease,  under  which  her  child  labors,  run  on 
guessing  it  will  be  better  to-morrow,  that  she  may 
save  the  trifle  of  the  physician’s  fee,  must  have  some 
moral  obliquity,  and  exposes  herself  to  reflections  if 
it  dies,  than  which  I can  conceive  of  nothing  more 
terrible,  and  which  must  be  to  her  ever  the  most 
exquisite  torture,  unless  indeed,  her  conscience  be 
more  impenetrable  than  adamant.  It  is  rarely  the 
case  that  physicians  themselves  will,  when  their 
children  are  sick,  trust  to  their  own  judgment,  but 
rely,  unless  the  attack  is  very  slight,  upon  some  medi- 
cal friend  in  whom  they  have  confidence.  If  then 
a father’s  anxiety  unfits  him,  after  years  of  study,  to 
treat  his  own  family,  should  a mother  venture  to 
dose  her  child,  when  grave  symptoms  threaten  ? I 
certainly  will  not  consent  to  aid  in  producing  the 
impression  that  she  may. 

There  is  sometimes  hesitation  in  sending  for  the 
medical  attendant  of  a family  when  a child  seems 
quite  sick,  and  the  parents  feel  very  anxious,  from  fear 
that  he  will  think  it  was  not  necessary.  Some  prac- 


OF  SICK  CHILDREN. 


131 


Better  to  send  for  the  doctor  than  to  he  anxious. 


titioners,  I regret  to  say,  do,  when  the  child  is  not  so 
sick  as  the  fond  mother  feared,  indulge  in  ridicule  of 
her  anxiety,  but  it  seems  to  me  that  no  one  can  whose 
heart  is  really  that  of  a gentleman.  I do  not  fear 
that  it  will  be  attributed  to  a mercenary  motive, 
when  I urge  my  patrons  to  send  to  me  at  once,  rather 
than  suffer  such  anxiety,  for  I explain  to  them  the 
simple  reason,  thus  : in  the  diseases  of  children,  a 
few  hours  sometimes  makes  an  immense  difference  in 
the  result,  that  going  beyond  the  reach  of  medicine 
which  at  an  earlier  time  might  have  been  checked. 
If  then,  with  the  knowledge  of  this  fact,  the  mother 
becomes  very  anxious,  by  sending  at  once  she  will 
not  have  to  reproach  herself  in  any  event  for  an 
unwise  delay,  and  if  the  disease  is  serious,  the  safety 
of  the  child  may  be  secured.  If  the  disease  is  unim- 
portant, the  relief  to  her  own  feelings  which  the 
assurance  gives,  is  well  worth  my  fee,  while  the  child 
may  be  saved  much  unnecessary  dosing. 

In  what  follows  I have  not  dwelt,  on  many  of  the 
signs  of  water  on  the  brain,  and  other  fearful  dis- 
eases, for  where  they  are  known  to  the  mother,  the 
knowledge  not  only  does  her  no  good,  but  causes  her 
a vast  amount  of  unnecessary  anxiety.  My  inten- 
tion is,  to  give  directions  for  the  mother  in  her 


132 


OF  SICK  CHILDREN. 


The  duties  of  the  mother  and  the  physician.  How  to  know  when  a child  is  sick. 

proper  sphere,  not  as  physician,  but  as  nurse  to  her 
sick  child.  Her  duties  are  as  necessary  as  those  of 
the  physician,  but  they  are  entirely  different  from 
his ; both  go  on  admirably  together,  while  each  occu- 
pies its  proper  sphere,  but  when  the  mother  assumes 
the  responsibility,  which  she  sometimes  does,  of  dis- 
obeying or  neglecting  the  physician’s  directions,  she 
does  him  an  injustice,  endangers  the  life  of  her  child, 
and  assumes  for  herself  a fearful  burden. 

Of  the  General  Signs  of  Disease . 

To  those  who  are  not  accustomed  to  the  care  of 
children,  it  seems  a difficult  problem  to  ascertain 
when  they  are  sick,  or  this  being  known,  to  tell 
what  is  the  matter.  There  is  not,  however,  as  much 
difficulty  as  might  be  anticipated,  but  in  order  that 
the  physician  may  form  a right  judgment  of  the 
child’s  condition,  it  is  necessary  for  the  mother  to 
observe  carefully  the  peculiarities  which  the  child 
presents.  With  this  aid,  even  before  children  talk, 
or  before  they  have  learned  the  sign  language  which 
precedes  speech,  children  give  very  certain  indi- 
cations of  sickness.  The  only  fear  is  that  the 
presence  of  the  strange  face  of  the  physician  will, 
after  they  are  a year  or  two  old,  make  them  a little 


OP  SICK  CHILDREN. 


133 


The  contrast  between  the  healthy  and  the  sick  child. 

diffident,  so  that  they  will  not  make  known  their 
feelings.  Under  these  circumstances  the  mother’s 
observations  become  doubly  valuable  and  important. 

The  healthy  child  is  usually  active ; its  eye  is 
bright,  its  arms  and  legs  are  tossed  about  in  very 
joy  of  living,  or  serve  it  as  playthings,  a constant 
wonderment  and  a constant  amusement.  If  a little 
older,  it  is  almost  constantly  running  about  or  occu- 
pied with  its  toys,  finding  in  this  perpetual  motion 
its  invigorating  exercise  and  one  means  of  its  fuller 
development.  When  the  child  becomes  sick,  this 
ceases.  Its  eyes  become  dull  and  heavy,  or,  though 
it  is  very  rare,  extremely  bright.  It  lies  still,  or  if 
it  moves  about,  it  is  languidly  and  with  difficulty, 
and  for  but  a few  moments.  The  very  young  infant 
ceases  to  toss  up  its  arms,  or  to  hold  up  its  fists  near 
its  mouth  (“  squaring  off  at  existence,”  as  Dickens 
calls  it),  but  lies  in  the  lap  or  arms  without  the 
feeling  of  self  support,  of  elasticity  which  it  has  in 
health,  becoming  almost  flaccid  as  if  it  would  bend 
or  move  in  any  direction.  There  is  some  truth  in 
the  observation  that  a healthy  child  throughout  the 
first  year  sleeps  with  its  hands  somewhat  raised  ; 
that  is,  they  do  not  lie  by  its  side,  but  are  doubled, 
lying  usually  on  its  chest  and  near  to  its  chin.  In 


134 


OP  SICK  CHILDREN. 


Position  of  the  hands.  Excessive  heat  of  the  body  generally 

some  diseases  of  the  brain  the  child  throws  its  arms 
above  its  head  or  strikes  its  forehead  with  them, 
and  it  is  important  that  such  a habit  should  be  made 
known  to  the  physician.  More  frequently  the  hands 
are  permitted  to  fall  by  the  side,  and  this  occurs  in 
diseases  such  as  diarrhoea,  which  prostrate  the 
strength.  The  arms  fall  in  any  direction,  and  with- 
out any  apparent  effort  to  direct  them.  When 
strength  begins  to  return,  the  hands  again  resume 
their  favorite  position,  the  change  being  gradual. 

One  of  the  most  common  and  earliest  class  of 
signs  of  departure  from  perfect  health,  is  derived 
from  the  heat  of  the  body,  which  changes  both  gen- 
erally and  locally.  In  health  the  skin  of  the  child 
is  warm,  but  it  is  pleasantly  so,  and  the  surface  feels 
smooth  and  soft.  In  very  many  diseases  it  becomes 
very  hot  throughout  its  whole  extent,  giving  to  the 
hand  the  sensation  of  burning,  while  the  skin  seems 
rough  and  hard.  This  may  be  from  the  irritation  of 
the  teeth,  or  it  may  be  caused  by  some  approaching 
disease,  as  a fever.  It  is  a state  of  things  that  calls 
for  attention.  The  child  should  be  carefully  watched 
to  see  if  it  is  accompanied  by  any  other  symptom, 
as,  for  instance,  vomiting.  Its  teeth  should  be 
looked  at  to  see  if  it  is  not  from  the  pressure  of 


OF  SICK  CHILDREN. 


135 


Hot  hands  not  always  evidence  of  disease. 


some  of  them  upon  the  gum,  or  enquiry  should  be 
made  if  it  has  played  too  hard,  or  eaten  any  inju- 
rious food.  This  dry,  burning,  general  heat  is  not  a 
symptom  which  points  out  the  existence  of  any 
special  disease,  but  it  shows  that  there  is  some 
disturbance  of  the  economy,  the  cause  of  which 
should  be  looked  for,  and  if  possible  removed. 

I said  that  excessive  heat  was  sometimes  local. 
The  hands,  the  head,  and  the  body,  are  the  usual  seats 
of  it.  The  palms  of  the  hands  are  frequently  found 
to  be  of  an  unusual  temperature,  and  by  the  early 
observation  of  this  phenomenon,  the  physician  or  the 
parent  may  obtain  a clue  to  the  existence  of  other 
disturbances.  Still  the  child  is  not  to  be  considered 
as  sick  for  this  reason  only.  When  a child  is  too 
much  fatigued  or  excited,  especially  if  it  is  of  a 
nervous  temperament,  the  palms  will  very  frequently 
be  observed  to  be  hot.  No  disease  in  this  case  can 
be  said  to  exist,  but  the  mother  should  understand 
the  repeated  occurrence  of  the  heat  to  indicate  the 
necessity  of  providing  less  fatiguing  sports,  or  lon- 
ger periods  of  rest  for  the  child  ; or  else  of  guarding 
against  the  undue  excitement  to  which  it  is  subject. 
The  same  heat  is  produced  by  the  irritation  of  the 
teeth  as  they  come  through  the  gum,  and  might 


136 


OF  SICK  CHILDREN. 


Hot  hands.  Causes  of  too  great  heat  of  the  head. 

perhaps  be  properly  referred  to  the  same  nervous 
excitement,  which  I have  before  mentioned,  as  pro- 
ducing it.  Derangement  of  the  stomach  is  frequently 
accompanied  by  the  same  heat. 

Thus  it  will  be  evident  that  the  fact  that  the 
palms  of  the  child’s  hands  are  frequently  too  hot,  is 
not  sufficient  reason  to  dose  it  with  medicines,  but  it 
is  a sufficient  reason  to  look  carefully  for  its  cause, 
and  that  should  be  removed  at  once,  if  possible. 

The  head  is  another  part  of  the  body  which  is 
frequently  too  hot.  This  is  perceptible  to  the  touch 
of  the  hand,  and  is  to  be  sometimes  noticed  on 
the  forehead,  sometimes  in  the  back  of  the  head. 
When  this  is  slight,  it  is  not  necessary  to  take  a 
great  deal  of  notice  of  it,  but  ascertain,  if  possible, 
whether  or  not  there  is  any  apparent  cause  for  it. 
Such  disturbances  as  I have  before  mentioned,  as 
causing  too  great  heat  of  the  palms,  will  produce 
slight  heat  of  the  head.  From  teething,  however,  it 
may  be  very  great.  As  a general  rule,  when  the 
heat  of  the  head  becomes  very  marked,  if  there  is 
no  vomiting,  or  twitching  of  the  arms  or  face,  or 
any  other  indication  of  illness,  it  can  be  allayed  by 
bathing  the  head  with  cool  (not  very  cold)  water. 
If  the  child  is  constipated,  a mild  purgative  may  be 


OP  SICK  CHILDREN. 


137 


What  to  do  when  the  head  is  too  hot. 


used,  say  a half  teaspoonful  or  more  of  spiced  syrup 
of  rhubarb,  sufficient  to  produce  a single  movement ; 
or  better  still,  an  injection  of  a teaspoonful  of  sweet 
oil  poured  upon  a half  teacupful  of  warm  water, 
may  be  given. 

If  the  heat  of  the  head  increases  and  becomes 
very  great,  the  child  tossing  his  head  from  side  to 
side,  or  rolling  it  uneasily ; or  if  there  are  any 
twitchings  of  the  face,  eyelids,  or  mouth  ; or  if  the 
child  cries  with  pain,  putting  its  hands  to  its  head, 
starting  suddenly  in  its  sleep,  or  waking  with  a 
frightened  air,  it  is  wiser  to  call  in  the  physician. 
Mothers  need  not  suppose  that,  if  all  these  symptoms 
exist  in  combination,  the  child  is  necessarily  going 
to  have  inflammation  of  the  brain,  or  that  terror  to 
all  mothers,  “ water  on  the  brain.”  Still  the  fact 
that  in  the  nervous  system  of  the  child,  the  brain 
holds  a large  proportion,  that  its  diseases  are  always 
serious,  and  sometimes  commence  suddenly,  at  others 
insidiously,  it  is  better  to  place  the  responsibility  of 
its  care  where  it  properly  belongs,  viz  : on  the  physi- 
cian, and  save  the  child  from  all  unnecessary  risks 
of  danger. 

Unusual  heat  of  the  body  may  be  either  over  the 
chest,  that  is,  over  the  ribs,  or  over  the  bowels.  It 


138 


OF  SICK  CHILDREN. 


Local  heat  of  other  parts.  Cold  feet. 

should  be  remembered  that  the  body  of  the  healthy 
child  feels  quite  warm  beneath  its  clothing,  and  it  is 
not  necessary  to  be  alarmed  because  this  is  the  case. 
Extreme  heat  of  the  chest,  as  well  as  abdomen,  is 
noticed,  of  course,  when  the  approach  of  a fever  has 
thrown  the  whole  system  into  unusual  heat.  Very 
marked  heat  of  the  chest  alone,  accompanies  only 
inflammation  of  the  lungs  or  some  of  their  parts ; 
that  is,  it  accompanies  only  inflammation  of  those 
organs  which  are  contained  within  it.  Now  all  of 
these  are  accompanied  by  other  symptoms,  which 
indicate  the  same  disease,  and  are  all  too  grave  for 
the  mother  to  think  for  a moment  of  treating  them. 

Excessive  heat  of  the  abdomen  frequently  accom- 
panies diseases  of  the  bowels,  that  is,  it,  like  heat  of 
the  chest,  is  an  accompaniment  of  disease  of  the 
organs  which  are  contained  within  the  correspond- 
ing cavity.  Here  it  is  not  necessarily  a serious 
sign,  though,  when  a child  is  ailing,  it  is  well  to 
notice  whether  or  not  it  exists. 

The  feet  are  more  apt  to  be  too  cold  than  too 
hot,  and  this  is  the  especial  fact  that  is  to  be 
observed.  Cold  feet  frequently  accompany  too 
great  heat  of  the  head,  as  if  the  heat  which 
belonged  to  them  had  been  drawn  off  to  the 


OP  SICK  CHILDREN. 


139 


Position  of  the  sick  child. 


brain.  Affections  of  the  bowels  are  accompanied 
by  them,  and  especially  colic.  A feeble  child  is 
very  apt  to  be  subject  to  them,  and  the  remedy  is 
a building  up  of  the  constitution,  an  invigoration  of 
the  life  powers,  and  an  improvement  of  the  blood- 
making  process.  Warmer  clothing  is  usually  a 
necessary  assistant,  but  it  must  be  accompanied  by 
those  measures  which  tend  more  perfectly  to  restore 
the  health.  Clearly,  nothing  can  be  laid  down  as  a 
general  rule  of  treatment,  adapted  to  all  conditions. 
A physician’s  advice  should  be  taken  and  followed. 

I have  alluded  to  the  fact,  that  the  child,  as  it 
grows  sick,  lies  more  helpless  in  the  nurses  arms,  or  on 
its  bed.  Its  position  and  motion  are  sometimes  indi- 
cative of  the  part  diseased,  and  if  any  peculiarity  in 
these  is  observed,  it  should  be  mentioned  to  the 
physician  at  his  first  succeeding  call.  With  some 
diseases  of  the  bowels  the  child  keeps  its  legs  curled 
up,  drawing  its  knees  well  towards  its  chest,  being 
quite  unwilling  to  straighten  out  its  legs.  Instinct 
teaches  it  that  it  is  most  comfortable  in  that  posi- 
tion, and  it  therefore  assumes  it.  At  other  times  it 
allows  its  legs  to  lie  in  any  direction,  caring  as  little 
for  their  position  as  for  that  of  its  arms.  Or  again 
it  will  draw  them  up  and  throw  them  down,  indi- 


140 


OF  SICK  CHILDREN. 


Rolling  the  head.  Expression  of  the  face. 

eating  in  tins  way  its  restlessness  and  uneasy 
feelings. 

The  head  and  face  also  give  by  their  position, 
indications  of  importance,  which  are  to  be  observed 
and  reported  to  the  physician.  Boiling  the  head 
from  side  to  side,  is  a common  accompaniment  of 
disease  of  the  brain,  but  it  is  not  a certain  indica- 
tion of  it,  as  is  thought  by  some.  It  should  lead  to 
increased  care  and  attention,  a more  minute  observ- 
ance of  the  condition  of  the  child,  but  it  need  not 
be  viewed  as  a sign  of  disease  beyond  relief.  I 
dwell  upon  this  more  particularly,  because  it  will,  I 
hope,  lessen  some  of  the  unnecessary  anxiety  of 
mothers. 

The  face,  by  its  varying  expressions,  gives  very 
valuable  indications  of  disease.  Its  general  expres- 
sion may  be  that  of  pain  or  of  listlessness,  of 
suffering,  or  of  that  indifference  to  everything  which 
is  scarcely  less  pitiable  in  a child.  A heavy,  dull 
look  is  among  the  earliest  indications  of  ill-health. 
Instead  pf  the  illumination  of  the  face  with  which 
the  infant  soon  learns  to  greet  its  mother,  there  is  a 
half  recognition,  and  a drowsy,  dull  look,  or  when 
it  has  gone  further,  even  the  first  bright  glance  does 
not  appear.  Most  of  the  ordinary  disturbances  of 


OP  SICK  CHILDREN 


141 


Expression  of  the  mouth. 

the  health  are  accompanied  by  this  change  in  the 
expression,  which  experienced  mothers  learn  to 
interpret,  by  saying  that  the  child  does  not  look 
well.  The  cause  of  it  should  be  sought,  and  if  pos- 
sible removed.  It  may  be  the  only  indication  which 
is  apparent,  of  a headache,  and  it  may  be  the  first 
announcement  of  an  approaching  fever. 

From  the  features  many  indications  of  disease  are 
drawn.  The  mouth  is  particularly  expressive. 
When  a child  is  sick  at  its  stomach,  there  may 
usually  be  noticed  a pale  circle  about  the  mouth, 
and  an  expression,  not  like  pain,  nor  like  that  which 
we  notice  in  adults  who  are  nauseated,  but  quite 
peculiar,  and  when  once  seen  not  forgotten.  The 
lips  lose  their  color  in  a measure,  and  yet  just  outside 
of  their  margin,  extending  to  the  nose  on  the  upper 
side,  to  the  middle  of  the  chin  below,  and  to  about 
the  same  distance  all  around,  there  is  a more  or  less 
marked  white  circle.  The  lips  are  not  usually 
pressed  together,  but  slightly  parted.  The  distinct- 
ness of  this  circle  and  the  whole  expression  increase 
with  the  degree  of  nausea,  so  that  we  thus  have  a 
valuable  indication  of  its  intensity.  For  its  treat- 
ment, turn  to  what  is  subsequently  said  of  vomiting. 

At  other  times  the  lips  may  be  noticed  to  be 


142 


OF  SICK  CHILDREN. 


Expression  of  the  nose.  Flushing  of  the  face. 

pressed  together  with  some  degree  of  firmness, 
while  a white  band,  usually  less  marked  than  that 
which  I have  before  spoken  of,  surrounds  them.  At 
the  same  time  that  this  occurs,  there  will  be  a pecu- 
liar expression  given  to  the  nose  by  the  contraction 
of  one  of  its  muscles.  It  seems  like  a pinching  in 
of  the  nostrils,  as  if  they  were  drawn  together  at 
their  base.  This  is  an  indication  of  pain,  not  of 
nausea.  The  seat  of  the  pain  is  the  abdomen,  and 
this  expression,  particularly  when  accompanied  by  a 
drawing  up  of  the  legs,  and  a curling  of  the  body, 
is  a sign  of  colic.  It  can  sometimes  be  seen  to  pass 
over  the  face  and  again  to  go  off,  returning  with 
every  paroxysm.  When  observed  in  the  physician's 
absence,  it  should  be  mentioned  to  him  on  his  next 
visit. 

The  face  of  the  child  sometimes  flushes  for  a few 
moments,  becoming  again  pale.  There  is  no  danger 
of  mistaking  this  for  blushing  if  one  is  observing. 
There  is  the  want  of  expression  of  diffidence,  the 
absence  of  brilliancy  of  the  eye,  and  of  the  traces 
of  thought,  to  enable  one  to  distinguish  between 
them.  This  may  occur  in  cases  of  simple  feverish 
disturbance,  but  if  it  is  accompanied  by  restlessness 
at  night,  or  whenever  the  child  sleeps  j if  there  is 


OF  SICK  CHILDREN. 


143 


The  eyes  and  eyebrows. 

any  disturbance  of  the  natural  movement  of  the 
bowels,  particularly  if  they  are  constipated ; if 
there  is  any  starting  during  sleep,  or  moaning,  or 
terrifying  dreams  from  which  the  child  awakes  in 
fright,  it  should,  though  apparently  so  trivial  a sign, 
induce  the  :nother  to  consult  her  physician  without 
delay.  There  is  then  a combination  of  symptoms, 
indicative  of  the  first  stage  of  the  disease,  which 
often  terminates  in  water  on  the  brain,  and  as  this  is 
the  curable  stage,  it  is  important  that  it  should  be 
recognized.  Better  be  alarmed  too  soon  by  these 
symptoms  than  too  late. 

The  eyes  and  eyebrows  are  also  to  be  noted  in 
their  changes  of  expression.  I have  alluded  to  the 
dull,  heavy  look  of  the  eyes,  which  they  very 
frequently  have  when  any  gastric  or  feverish  dis- 
turbance exists.  It  does  not  need  to  be  more  par- 
ticularly described  to  be  recognized.  Any  crossing 
of  the  eyes,  where  it  has  not  before  existed,  should 
be  noted  and  made  known  to  the  physician,  that  its 
cause  may  be  removed  if  practicable.  I,  of  course, 
do  not  mean  if  it  is  simply  a habit  which  the  child 
has  learned  from  its  playmates,  as  is  sometimes  the 
case.  The  habit  should  be  broken  up  before  the 
crossing  becomes  permanent,  but  for  this  the  author- 
ity of  the  parents  ought  to  be  sufficient. 


144 


OP  SICK  CHILDREN. 


Evidences  of  pain.  Rolling  up  of  the  eyes. 

Languor  is  often  shown  by  the  mode  in  which  the 
lids  are  raised,  as  well  as  the  position  of  the  patient 
in  other  respects.  Inability  to  raise  the  lid  should 
be  at  once  made  known  to  the  physician. 

The  eyebrows  often  become  contracted,  a scowl 
passing  over  the  face  more  or  less  frequently.  If 
not  a mere  habit,  especially  if  accompanied  by  other 
symptoms  of  disease,  it  is  to  be  noted  as  an  expres- 
sion of  pain.  When  the  peculiar  paleness  about 
the  mouth  is  at  the  same  time  present,  together 
with  the  compression  of  the  lips,  it  may  be  set  down 
to  the  credit  of  pain  in  the  belly  ; but  if  these  are 
not  present,  and  the  head  is  hot,  the  hands  being  fre- 
quently raised  to  it,  it  may  be  attributed  to  headache. 

Many  a mother  has  suffered  great  anxiety  from 
the  fact  that  her  child  does  not  entirely  close  its 
eyes  while  sleeping,  worms  being  the  least  of  the 
evils  which  are  supposed  to  cause  it.  When  this  is 
observed,  it  is  at  the  same  time  noted  that  the 
colored  portion  of  the  eye  is  not  in  the  position 
which  it  occupies  between  the  lids  while  the  child 
is  awake,  but  is  either  not  seen,  or  only  the  lower 
edge  of  it  is  visible  just  below  the  upper  lid.  All 
anxiety  on  this  score  is  unnecessary.  The  half  open 
lids  are  evidence,  if  no  other  very  grave  symptom 


OF  SICK  CHILDREN. 


145 


exists,  that  the  child  does  not  sleep  very  soundly,  hut 
is  rather  in  a deep  drowse.  It  is  true  that  where 
worms  are  annoying  it  and  preventing  sound  sleep, 
the  eyes  have  this  appearance,  hut  it  also  comes  from 
the  disturbances  produced  by  gases  in  the  intestines 
(wind  in  the  stomach,  in  popular  phraseology),  or 
from  undigested  food,  or  from  slight  pain  in  the 
abdomen.  The  rolling  up  of  the  eyeballs  is  simply 
what  occurs  with  every  one  when  we  close  the  lids, 
but  from  their  being  partly  open  the  lower  edge  of 
the  iris  comes  in  sight,  or  all  is  white.  Of  this  turn- 
ing  upward  of  the  balls,  one  can  be  satisfied  by 
putting  the  finger  on  the  lids  and  feeling  the  direc- 
tion taken  by  the  prominence  of  the  cornea  as  the 
eye  is  fairly  shut,  and  a decided  effort  of  the  will  is 
necessary  to  prevent  it. 

This  is  perhaps  the  best  place  to  add  that  to  see  a 
sick  child  shed  tears  is  always  a good  sign.  When 
it  occurs  after  protracted  or  severe  sickness,  it  may 
be  looked  upon  almost  as  a crisis,  affording  as  it 
does,  evidence  of  improvement.  But  the  converse 
of  this  proposition  does  not  hold  true,  namely,  that 
if  the  patient  does  not  shed  tears,  the  case  is  very 
grave.  It  may  or  may  not  be,  and  no  judgment  can 
be  draw  from  it. 

10 


146 


OF  SICK  CHILDREN. 


Intolerance  of  noise  and  light. 

When  a child  gives  any  indication  of  being 
unwell,  it  is  wise  to  notice,  especially  if  there  is 
excessive  heat  of  the  head,  whether  or  not  light  and 
noise  trouble  it.  If  on  being  carried  towards  the 
window  it  shuts  its  eyes,  wholly  or  in  part,  wrinkling 
them  with  that  expression  which  adults  have  when 
they  have  a headache  and  shun  the  light,  it  should 
be  reported  to  the  physician.  This  accompanies 
simple  headache  in  children,  as  well  as  in  adults,  but 
is  sometimes  of  more  importance.  If  noise  troubles 
the  child  it  will,  if  able  to  talk,  say  so,  but  if  not 
there  will  be  increased  restlessness,  a cringing  when 
the  door  is  shut  violently,  and  an  evident  effort  to 
avoid  every  jarring  sound.  Slight  but  unexpected 
sounds  will  startle  it,  making  it  spring  forward  as 
only  loud  sounds  will  do  when  it  is  well. 


OF  PARTICULAR  SYMPTOMS.  147 

Vomiting  a common  symptom. 


Chapter  X. 

OF  PARTICULAR  SYMPTOMS. 

Of  Vomiting . 

Vomiting  is  a common  symptom  of  disease  with 
children,  being  sometimes  a serious,  sometimes  an 
unimportant  one.  I have  before  alluded  to  the  fact, 
that  children  who  are  nursing,  often  throw  out  of 
their  mouths  a portion  of  the  milk  they  have  just 
swallowed,  almost  as  soon  as  they  have  done  taking 
it.  This  is  not  sour,  or  at  all  curdled,  and  is  in  fact 
the  result  of  over-filling  the  stomach.  As  soon  as 
the  child  ceases  to  distend  it  by  crowding  more 
milk  into  it,  it  contracts  to  dimensions  not  so 
unusual,  and  thus  squeezes  out — so  to  speak  — a 
part  of  the  milk,  which  finds  its  readiest  outlet 
through  the  mouth.  This,  I repeat,  is  not  vomiting, 
and  only  suggests  that  the  child  should  not  be 


148 


OP  PARTICULAR  SYMPTOMS. 


Acidity  cf  the  stomach.  Throwing  off  bile. 

allowed  to  nurse  so  long.  Its  greediness  must  be 
checked. 

But  real  vomiting  may  occur  from  crowding  the 
stomach  with  food.  In  this  case,  however,  it  does 
not  follow  immediately  upon  taking  the  food,  but 
some  time  after,  and  is  the  result  of  indigestion. 
More  food  is  taken  than  the  stomach  can  digest,  and 
it  remains  within  it,  changed  only  by  becoming  sour. 
More  or  less  feverishness  and  loss  of  appetite  occur, 
and  perhaps  a headache,  which  is  not  relieved  till 
the  contents  of  the  stomach  are  discharged  by  vom- 
iting, or  till  their  acidity  has  been  corrected  by  an 
alkali,  as  soda  and  saleratus,  and  after  a time  been 
digested.  When  vomiting  continues  a long  time 
the  food  contained  in  the  stomach  having  been 
thrown  off,  there  is  then  discharged  a dark,  bitter 
substance  known  as  bile.  It  is  not  unfrequently 
said,  when  this  appears,  that  it  is  well  to  have  such 
vile  stuff  out  of  the  stomach,  and  emetics  are 
actually  given  to  promote  its  discharge.  The  bile 
enters  the  stomach,  usually,  from  the  very  excess  of 
vomiting  which  discharges  it.  There  seems  to  be  a 
movement  of  the  upper  part  of  the  intestines,  tend- 
ing to  carry  its  contents  up  to  the  stomach,  similar 
to  that  in  the  stomach  tending  to  throw  its  contents 


OP  PARTICULAR  SYMPTOMS.  149 


What  to  do  when  a child  is  sick  at  the  stomach. 

into  the  mouth.  The  appearance  of  bile  in  the  mat- 
ters thrown  off  is,  therefore,  rather  indicative  of  the 
necessity  of  stopping  the  vomiting  as  soon  as  possi- 
ble, than  of  the  desirableness  of  continuing  the 
action,  by  giving  warm  water  or  any  more  pow- 
erful emetic.  In  extremely  rare  cases  this  same 
movement,  in  the  wrong  direction,  occurs  throughout 
the  intestines  till  the  contents  of  the  lower  bowel 
have  been  discharged  by  the  mouth.  I mention  this 
as  illustrative  of  the  more  limited  action. 

The  best  course  to  pursue  when  a child  is  very 
much  nauseated,  if  there  has  not  been  a free  and 
complete  discharge  of  the  contents  of  the  stomach, 
is  to  give  a full  draught  of  lukewarm  water  to  pro- 
voke and  assist  that  discharge.  Should  it  have 
been  before  accomplished,  it  is  then  better  to  make 
efforts  to  check  it.  This  is  best  done  by  giving  bits 
of  ice,  almost  as  fine  as  it  can  be  chipped,  and  very 
freely.  Or,  if  this  fail,  a very  small  mustard  poul- 
tice, not  more  than  one  or  two  inches  square,  can  be 
put  upon  the  pit  of  the  stomach,  but  should  not  be 
allowed  to  remain  there  more  than  two  minutes,  for 
fear  of  producing  a blister.  It  is  better  to  replace 
it,  if  it  is  necessary,  than  to  cause  the  child  to  suffer 
too  severely. 


150  OP  PARTICULAR  SYMPTOMS 

Constipation  a relative  term. 

When  the  stomach  still  seems  to  be  sour,  even 
after  vomiting  has  occurred,  a small  quantity  of 
soda  may  be  dissolved  in  water  so  that  it  does  not 
taste  very  strong,  and  given  till  the  acidity  is  cor- 
rected. If  the  vomiting  is  obstinate,  whether  it  is 
accompanied  by  constipation  or  diarrhoea,  it  is  bet- 
ter to  send  for  the  physician. 

Of  Constipation,  Diarrhoea,  fyc. 

The  evacuations  of  the  bowels  vary  in  sickness 
very  much.  I have  said  that,  in  the  most  desirable 
condition  of  the  infant,  there  is  a discharge  from  the 
bowels  very  regularly  twice  or  three  times  in  the 
twenty-four  hours.  The  habit  of  different  individ- 
uals is  different,  but  in  children  it  ought  not  to  vary 
much  from  this  standard.  Still,  the  child  who 
habitually  has  three  movements  each  day,  would 
be  considered  as  constipated  if  only  one  occurred ; 
while  the  child  accustomed  to  but  one,  although  of 
a habit  tending  to  constipation,  would  not  be  exactly 
considered  as  in  that  condition,  unless  at  least  one 
entire  day  should  pass  without  a movement.  For 
this  reason,  constipation  within  certain  limits  is  rel- 
ative. So,  too,  it  is  with  the  opposite  condition,  of 
diarrhoea,  and  this  must  be  borne  in  mind  by  the 
mother. 


OP  PARTICULAR  SYMPTOMS.  151 


Treatment  of  constipation.  Injections. 

Constipation,  if  slight,  and  occasionally  but  not 
frequently  present,  may  be  relieved  by  using  the 
aromatic  syrup  of  rhubarb,  of  which  about  half  a 
teaspoonful  may  be  given  to  a child  within  the  first 
year,  and  the  quantity  may  subsequently  be  increased, 
according  to  the  age  and  strength  of  the  child.  I 
prefer  this  to  castor  oil,  for  various  reasons — among 
others,  that  it  is,  when  diluted  with  a little  water 
taken  much  more  readily.  But  when  the  consti- 
pation is  habitual,  it  is  preferable  to  resort  to 
injections,  either  of  simple  water,  of  a mild  soap 
suds,  or  of  either  of  them  combined  with  sweet  or 
castor  oil.  Of  the  mode  of  preparing  and  giving 
these,  a full  description  will  be  found  in  the  chapter 
on  “ The  Management  of  the  Sick  Room.”  It  is  to 
be  remembered  that,  when  given  to  remove  a consti- 
pated habit,  they  must  be  regular  as  to  time — being 
given  at  the  same  hour  of  the  day,  as  nearly  as 
possible  — and  after  three  or  four  repetitions  the 
injection  of  one  day  may  be  omitted,  in  the  expecta- 
tion of  a movement  without  it.  The  next  day  the 
injection  should  be  repeated,  but  by  gradually 
lengthening  the  interval  between  their  adminis- 
tration, and  taking  care  that  the  habit  of  a 
movement  of  the  bowels  be  formed,  they  can 


152  OF  PARTICULAR  SYMPTOMS. 


Varieties  of  diarrhoea.  Green  discharges.  Jh/sentery. 

gradually  be  dispensed  with  — a thing  which  is 
always  to  be  intended  during  their  use. 

The  too  rapid  and  frequent  movement  of  the 
bowels  should  be  checked  by  some  simple  means, 
or  if  these  do  not  suffice,  the  physician’s  advice 
should  be  sought.  Perhaps  these  observations  may 
be  of  use.  A diarrhoea  which  consists  simply  of 
stools  rather  loose  but  otherwise  of  natural  appear 
ance  is  the  least  important ; when  they  become  quite 
watery,  and  their  several  ingredients  seem  separate 
and  unmixed,  it  is  more  grave.  Yery  watery  dis- 
charges, especially  when  vomiting  is  at  the  same 
time  present,  give  a grave  indication.  Green  dis- 
charges will  frequently  be  found  to  be  of  some 
other  color  at  the  moment  of  passing,  but  to  be 
rapidly  changed  by  the  action  of  the  air,  or  of 
the  urine.  Some  discharges  are  green  when 
passed,  but  this  distinction  should  be  noted,  and 
the  physician  should  be  informed,  if  in  attend- 
ance, whether  or  not  it  is  the  influence  of  the 
air  and  urine  to  which  the  color  is  due.  Blood 
in  the  discharges  should  always  lead  to  increased 
vigilance  in  watching  the  child’s  condition.  Slight 
streaks  sometimes  proceed  from  unimportant  causes, 
but  when  there  is  a notable  quantity,  or  when  any 


OF  PARTICULAR  SYMPTOMS.  153 


Undigested  food  in  the  stools.  Its  sources.  Examination  of  discharges. 


appears  at  the  same  time  that  the  child  is  hot  and 
feverish,  and  suffers  from  great  pain  in  the  belly, 
there  is  much  reason  to  fear  that  the  disease  is  dys- 
entery instead  of  diarrhoea.  This  should  permit  no 
delay  in  placing  the  patient  in  the  care  of  the  physi- 
cian, or  if  he  is  already  attending  Ihe  child,  the 
appearance  of  the  blood  and  the  other  symptoms 
should  be  at  once  made  known  to  him.  Food 
frequently  appears  in  the  discharges  in  an  undi- 
gested state.  If  the  diet  is  milk,  curds  make  their 
appearance,  and  if  it  is  more  artificial,  the  pieces 
which  make  their  appearance  are  plainly  the  parts 
of  the  various  articles  eaten.  In  this  way  the 
offending  substance  is  often  detected,  and  thus  the 
imprudent  giver  of  it  is  found  out.  Nurses  are 
very  prone,  before  as  well  as  after  a child  is  weaned, 
to  give  him  something  which  he  holds  out  his  hand 
for,  because  he  sees  others  eating  it.  The  first  inti- 
mation the  mother  has  of  it  is  from  the  restlessness 
of  the  child,  accompanied,  or  soon  followed,  by  a 
loose  discharge  from  the  bowels.  A careful  exami- 
nation' of  the  evacuations,  after  suspicious  symptoms, 
should  always  be  made,  so  that  it  may  be  distinctly 
known  whether  or  not  there  is  indigestion  of  the 
ordinary  food,  which,  if  habitual,  should  lead  to  a 


154  OF  PARTICULAR  SYMPTOMS. 


Why  cathartics  are  given.  Curds  in  the  stools , 

modification  of  it ; or,  if  the  nurse  has  been  unfaith- 
ful or  imprudent  in  giving  forbidden  food,  or 
dishonest  in  concealing  what  she  has  done.  There 
frequently  is  no  other  way  to  detect  this  latter  fault, 
and  it  is  so  common,  that  no  nurse  should  be  implic- 
itly trusted  till  she  has  been  watched  for  months, 
and  her  statements  have  in  this  way  been  verified. 
The  early  discharge  of  these  offending  matters  is  the 
most  fortunate  occurrence,  for  when  they  remain  in 
the  intestines,  after  leaving  the  stomach,  they  are 
not  digested,  but  continue  to  produce  a serious 
amount  of  irritation,  which  may  cause  convulsions. 
It  is  for  this  reason  that  it  is  customary  to  give  a 
mild  cathartic,  as  castor  oil  or  syrup  of  rhubarb, 
where  there  is  feverishness  and  restlessness,  espe- 
cially in  a weaned  child,  and  the  condition  of  the 
gums  is  not  such  as  to  lead  one  to  think  that  the 
pressure  of  the  teeth  produces  it. 

When  curds  appear  in  the  discharges  of  nursing 
children,  the  probability  is  that  they  are  caused  by 
over  feeding.  The  child  nurses  too  long  or  too 
often,  more  probably  the  latter,  and  the  stomach  is 
only  able  to  curdle  the  milk,  without  digesting  it 
completely.  It  must  then  be  thrown  off  by  vomit- 
ing, or  pass  through  the  intestines.  The  remedy  for 


OF  PARTICULAR  SYMPTOMS.  155 


Treatment  of  diarrhoea . Chalk  mixture. 

this  condition,  and  it  is  not  uncommon,  is  to  nurse 
the  child  at  longer  intervals,  or  to  give  it  less  at  a 
time ; and  it  is  most  probable  that  both  a longer 
interval  and  smaller  quantity  are  needed.  It  is 
possible  to  make  a glutton  of  the  child  at  the  breast, 
and  yet  no  mother  would  wish  to  do  so.  Prevention 
is,  in  this  case,  vastly  easier  than  cure.  A diarrhoea 
is  one  of  the  methods  by  which  nature  intimates  to 
the  mother  that  there  is  danger  in  this  respect. 

As  to  the  treatment  of  diarrhoea,  whole  pages 
might  be  filled  concerning  it,  and  yet  my  purpose 
does  not  allow  me  to  speak  of  it  too  minutely.  The 
regulation  of  the  diet  of  which  I have  just  spoken, 
is  one  mode  of  treatment,  and  a most  important  one. 
It  should  be  at  once  resorted  to,  and  if  it  is  no  t all 
that  is  needed,  it  will  be  always  necessary.  For  a 
child  that  is  nursed,  a diminution  of  the  quantity 
of  milk,  with  the  division  of  the  gums  when  swollen, 
will  usually  give  relief,  especially  if  increased  care 
is  taken  to  give  the  child  fresh  air.  The  sleeping 
apartment  should  be  well  ventilated,  and  at  least 
once  every  day  the  child  should  be  carried  out  to 
walk,  or  ride,  so  as  to  be  thoroughly  refreshed.  In 
fact,  all  those  conditions  which  I have  previously 
pointed  out  as  desirable  for  the  hygienic  care  of  the 


156  OF  PARTICULAR  SYMPTOMS. 


What  to  do  when  the  child  is  not  weaned.  The  diet  when  it  is  weaned. 

child,  should  be  scrupulously  attended  to.  If  this  is 
not  sufficient,  resort  may  be  had  to  chalk  mixture, 
containing  no  paregoric,  of  which  a half  or  even  a 
whole  teaspoonful  may  be  given  once  every  two  or 
three  hours.  This  medicine  should  always  be 
shaken  up  before  a dose  of  it  is  poured  out.  Dur- 
ing very  warm  weather,  it  is  apt  to  ferment,  and  for 
this  reason  I add  to  every  four  ounces  of  it  about 
one-half  ounce  of  the  compound  tincture  of  carda- 
moms, which  is  in  itself,  a very  good  medicine  in 
this  condition.  The  dose  of  the  mixture  may,  with 
this,  be  made  a little  smaller. 

When  a diarrhoea  occurs  in  a child  that  is  nursed 
in  part  and  fed  in  part,  it  should  be  at  once  confined 
to  its  mother’s  or  nurse’s  milk,  even  at  the  expense 
of  some  drain  upon  her.  This  is,  in  itself,  much 
towards  a cure,  but  the  chalk  mixture  may  also  be 
used,  if  necessary. 

If  the  child  is  weaned,  resort  must  be  had  to  a 
milder  diet.  Its  milk  must  be  boiled,  and  perhaps 
reduced  in  quantity,  or  a little  cream  may  take  the 
place  of  the  milk.  If  these  appear  still  to  irritate 
the  bowels,  it  may  be  well  to  carefully  try  changing 
to  the  milk  of  another  new  milch  cow,  or  goat,  and 
when  all  these  fail,  or  even  sooner  if  not  too  incon- 


OF  PARTICULAR  SYMPTOMS.  157 


The  diet  of  one  that  is  older. 

venient,  the  milk  of  a nurse  can  be  squeezed  from 
her  breast  and  fed  to  the  patient.  The  child  that  is 
weaned,  very  soon  forgets  how  to  nurse,  so  that  it 
cannot  usually  be  again  made  to  take  the  nipple. 

For  one  that  is  older,  and  that  has  become  accus- 
tomed to  a solid  diet,  it  is  necessary  to  pursue  a 
somewhat  different  course  as  to  minutim,  though  the 
principles  which  are  to  guide  in  selecting  are  the 
same.  All  substances  which  are  not  easily  digested 
are  to  be  at  once  abandoned.  The  diet  must  be 
limited,  both  as  to  its  elements,  and  to  its  quantity. 
Rice  is  one  of  the  articles  which  is  the  most  fre- 
quently resorted  to,  and  when  it  is  relished,  is  bene- 
ficial. The  usual  way  of  giving  it  is  boiled  in  milk, 
but  it  is  unimportant  how  it  is  cooked,  if  it  only  be 
thoroughly  done.  There  is  not  any  special  virtue  in 
rice,  as  some  seem  to  suppose,  which  justifies  its 
selection,  and  it  often  becomes  disagreeable  to  the 
child  if  given  continuously:  I have  known  the 
disgust  to  it  thus  acquired,  to  remain  unconquera- 
ble for  years.  Some  of  the  articles  enumerated 
previously,  while  speaking  of  the  diet  of  healthy 
children,  can  be  used,  more  particularly  those  which 
contain  a good  portion  of  starchy  ingredients.  Rice 
is  useful,  for  the  reason  that  almost  the  whole  of  it 


158  OF  PARTICULAR  SYMPTOMS. 


Rice.  Sweet  potatoes.  Bread  and  crackers. 

can  be  digested,  and  very  little  is  left  to  pass  along 
the  intestines,  by  its  irritation  causing  their  move- 
ments to  continue.  Had  the  rice  been  ground  up 
with  its  hulls  on,  this  would  not  be  so  ; but  the  undi- 
gested pieces  of  the  hull  would  constantly  irritate 
the  bowels,  and  rice  thus  prepared  would  be  one  of 
the  worst  possible  articles  of  diet  when  a diarrhoea 
existed.  I thus  illustrate  the  fact  that,  in  itself  it 
has  no  particular  curative  power,  and  that  other 
articles  can  be  selected,  which  will  be  equally  useful. 
The  sweet  potato  is  one  of  these,  but  it  should  be 
thoroughly  ripe  and  perfectly  sound,  and  never 
given  to  even  a healthy  child  if  it  has  become  in 
part  black,  or  has  the  smell  of  rose-water.  Arrow 
root  is  used  for  the  same  reason,  the  error  in  its  use 
consisting  chiefly  in  giving  it  to  too  young  children, 
whose  digestive ' organs  are  not  fitted  to  receive 
starchy  food.  Very  light  wheat  bread  and  crackers 
are  of  the  same  class,  but  bolted  flour  must  be  used, 
not  that  which  contains  any  of  the  hulls  (that  is, 
coarse  wheat  flour),  for  the  same  reason  that  rice 
ground  up  with  the  hulls  on,  would  be  rejected. 

Still,  the  child  will  often  require  something  beside 
this  diet.  Boiled  milk  is  a very  good  addition  to  it, 
containing  as”  it  does  many  of  the  elements  which  are 


OP  PARTICULAR  SYMPTOMS.  159 


Boiled  milk.  Soups.  Jellies  not  to  6e  relied  on  too  much.  Cold  drinlcs. 

required  in  the  nourishment  of  the  body.  When 
this  does  not  seem  to  agree  with  the  stomach,  or  to 
make  a variety  when  it  does,  soups  may  be  resorted 
to,  and  these  may  be  thickened  with  rice.  Under 
this  head  I include  all  animal  broths,  such  as  chicken 
water,  beef-tea,  and  the  like.  It  is  to  be  observed 
that  the  fat  is  always  to  be  carefully  skimmed  off, 
especially  if  chicken  is  the  meat  used,  the  fat  of  this 
fowl  frequently  appearing  to  act  as  a cathartic.  ’ I 
do  not  know  that  it  is  necessary  to  dwell  more 
minutely  upon  the  diet,  unless  it  be  to  add  that  it  is 
a mistake  sometimes  made,  to  confine  the  child  to 
animal  jellies,  such  as  those  made  from  calves’  feet, 
or  isinglass.  They  do  not  contain  the  materials 
necessary  to  nourish  the  child,  and  an  adult  confined 
to  them  would  soon  starve  to  death.  They  may  be 
used  occasionally,  or  as  a means  of  giving  wine  or 
brandy  to  the  patient  when  it  is  necessary,  but  this 
is  their  only  use. 

A child  with  diarrhoea  should  be  limited  in  its  use 
of  cold  drinks,  and  especially  of  water.  It  is 
usually  thirsty,  and  if  allowed  to  do  so,  will  drink 
very  large  quantities  of  water,  and  very  frequently. 
Its  milk  should  be  given  as  warm  as  it  will  bear  it, 
as  should  its  broths  and  other  liquids,  except  in  very 


160  OP  PARTICULAR  SYMPTOMS. 


How  to  allay  the  thirst. 

rare  cases,  when  vomiting  is  excessive,  and  it  is 
necessary  to  give  very  minute  quantities  of  iced 
fluids.  But  it  is  not  necessary  to  compel  the  child 
to  suffer  from  thirst.  Ice,  to  the  good  effect  of 
which,  in  vomiting,  I have  before  alluded,  is  to  be 
given,  and  in  the  same  way  — that  is,  by  chipping 
off  little  pieces  of  the  size  of  a bean,  and  putting 
them  occasionally  into  the  mouth.  It  is,  in  large 
measure,  the  heat  of  the  mouth  that  makes  the  child 
want  water,  and  even  iced  water,  especially  if  it  is 
given  in  teaspoonfuls  at  a time,  as  some  recommend, 
does  not  allay  the  sensation.  By  giving  ice  in  these 
small  bits,  but  little  water  is  taken  into  the  stomach, 
and  yet  the  mouth  is  cooled,  and  the  patient  is  sat- 
isfied. Any  one  can  try  the  experiment  of  drinking 
water  when  suffering  from  diarrhoea,  and  it  will  be 
found  that  a discharge  from  the  bowels  will  almost 
immediately  follow,  while  no  relief  will  be  afforded 
to  the  thirst.  But  by  taking  ice  in  bits  the  thirst  is 
satisfied,  and  the  movement  of  the  bowels  is  not 
stimulated. 

The  child  with  diarrhoea  should  be  kept  as  quiet 
as  possible,  and  sometimes  be  obliged  to  remain  in 
bed  for  this  reason.  All  exposure  to  being  chilled, 
as  from  the  night  air,  should  be  avoided,  at  the 


OP  PARTICULAR  SYMPTOMS.  161 


Prescription  for  weaned  children.  When  it  is  to  be  used. 

same  time  that  fresh  air  and  sunlight  are  carefully 
admitted. 

The  child  that  is  weaned  and  accustomed  to 
solid  diet  must,  as  to  medicines,  so  far  as  the  mother 
is  concerned,  be  treated  much  as  other  children, 
though  somewhat  more  powerful  astringents  may  be 
added  to  the  chalk  mixture.  A very  good  combi- 
nation is  this : — Take  of  chalk  mixture,  three 
ounces ; of  tincture  of  kino  (or  catechu),  half  an 
ounce ; of  compound  tincture  of  cardamoms,  half 
an  ounce.  Of  this,  the  dose  for  a child  eighteen 
months  old  is  one  teaspoonful  every  two  hours, 
if  the  discharges  are  very  frequent,  and  at  longer 
intervals  if  not — care  being  taken  to  shake  the 
bottle,  before  pouring  out  the  medicine.  I recom- 
mend this  mixture  with  confidence,  because  I have 
used  it  very  frequently  in  cases  of  simple  diarrhoea, 
and  usually  with  great  benefit.  By  no  means  would 
I intimate  that  it  will  cure  every  case,  but  it  cer- 
tainly does  many,  and  in  simple  diarrhoea  (for  I repeat 
it  is  for  this  disease  that  I recommend  it,  and  not 
for  cholera  infantum,  nor  for  dysentery),  mothers 
may  use  it  with  confidence.  It  is  well,  however, 
to  first  give  a teaspoonful  of  the  aromatic  syrup  of 
rhubarb,  especially  if  any  undigested  food  has  been 
11 


162  OF  PARTICULAR  SYMPTOMS. 


Flannel  to  be  worn  over  the  bowels . 

passed  ; a little  soda  can  be  added  if  there  is  acidity 
of  the  discharges. 

With  all  this  hygienic  and  medical  treatment,  if 
the  child  does  not  soon  improve — much  more,  if  it 
grows  worse  — the  physician  should  be  called. 

It  may  be  wise  to  add  that  while  a diarrhoea  lasts, 
and  longer,  if  the  child  is  subject  to  its  return,  a 
piece  of  flannel  should  be  worn  over  the  bowels,  and 
if  the  child  is  delicate,  a flannel  shirt  should  be 
put  on.  How  this  acts  I shall  not  pretend  to  say, 
but  I know  that  it  is  frequently  attended  with  great 
comfort  to  the  patient,  and  a manifest  improvement 
in  all  the  symptoms. 

When  vomiting  and  diarrhoea  commence  at  the 
same  time,  the  mother  should  not  trust  to  her  own 
skill,  especially  if  the  discharges  are  watery.  There 
is  too  much  reason  to  apprehend  that  the  disease  is 
cholera  infantum,  and  a physician  should  be  called. 

The  same  course  should  be  taken  when  blood 
appears  in  the  discharges,  dysentery  being  the  dis- 
ease in  that  case.  If  the  physician  cannot  soon  be 
present,  some  of  the  astringent  mixture  may  be 
given,  and  the  general  hygienic  treatment  which  I 
have  recommended  should  be  resorted  to ; but  he 
should  have  the  responsibility  of  the  case. 


OP  PARTICULAR  SYMPTOMS. 


163 


Ordinary  colds 


The  infant  does  not  spit  after  coughing 


Of  Coughs. 

It  is  not  necessary  for  me  to  define  exactly  what 
is  the  meaning  of  the  word  cough.  Every  mother 
knows  what  it  is,  better  than  I can  tell  her.  There 
are,  however,  various  kinds  of  cough,  which  it  is 
sometimes  important  that  she  should  be  able  to 
distinguish. 

Ordinary  colds,  accompanied  by  a discharge  from 
the  nose,  and  sometimes  by  an  unusual  amount  of 
the  secretion  of  tears,  frequently  give  rise  to  coughs 
of  various  degrees  of  severity,  and  with  different 
sounds.  The  chief  seat  of  the  disease  is,  at  one 
time  the  throat,  at  another  the  windpipe,  at  another 
the  smaller  air  tubes,  at  another  the  substance  of 
the  lung  itself,  and  at  still  another  the  outer  surface 
of  the  lung.  With  an  ordinary  cold,  however,  as 
the  phrase  is  commonly  understood,  there  is  at  first 
a dry  cough  which,  within  about  twenty-four  hours, 
becomes  looser,  and  with  each  cough  there  is  a rat- 
tling in  the  throat,  as  if  there  were  a quantity  of 
loose  phlegm  in  it.  This  is  in  reality  the  case,  and 
the  cough  brings  it  still  farther  up.  The  mother 
must  not  expect  that  the  young  child  will  spit  it  out. 
On  the  contrary,  it  is  swallowed.  To  learn  to  spit 


164  OF  PARTICULAR  SYMPTOMS. 


Clothing  of  a child  that  has  a cold. 


is  a matter  of  education,  requiring  a long  practice, 
though  our  people  have  the  reputation  of  becoming 
shockingly  skilful  in  it.  ' The  air  passage  is  cleared 
if  the  phlegm  is  swallowed,  or  if  it  is  expectorated, 
so  that  the  purpose  of  the  cough  is  as  well  answered 
in  one  case  as  the  other. 

This  ordinary  loose  cough  does  not  require  very 
active  treatment,  but  should  not  be  neglected. 
Mothers  are  apt  to  err  concerning  it,  by  giving  too 
much  medicine,  or  else  none  at  all.  The  first  thing 
to  be  done,  whenever  a child  has  a cold,  is  to 
observe  whether  or  not  it  is  sufficiently  dressed. 
If  its  neck  and  chest  are  bare,  its  legs  naked  from 
the  middle  of  the  calf  to  the  middle  of  the  thigh, 
and  its  arms  almost  entirely  uncovered,  it  is  of  no 
use  to  dose  it,  till  all  of  these  errors  are  corrected. 
The  disease  will  continue  in  spite  of  medication, 
just  as  a fire  will  burn  so  long  as  you  furnish  it  with 
fuel,  though  you  do  occasionally  pour  on  a little 
water.  Call  to  mind,  then,  the  advice  previously 
given  as  to  dress,  and  having  acted  accordingly, 
there  is  a strong  probability  that  remedies  will  be 
successful. 

For  a child  that  is  under  ten  years  of  age,  and  is 
laboring  under  a cold,  attended  with  cough,  I 


OF  PARTICULAR  SYMPTOMS.  165 


Treatment  of  ordinary  coughs.  Ipecacuanha. 

usually  direct  quite  small  doses  of  the  syrup  of 
ipecacuanha.  It  is  not  necessary,  nor  is  it  desira- 
ble, to  nauseate  the  child,  and  minute  doses  are 
better  to  commence  with,  it  being  easy  to  increase 
them  if  there  seems  occasion.  Different  children 
bear  different  doses  of  this,  as  well  as  other  reme- 
dies. To  a child  only  a month  or  two  old,  I do  not 
often  give  even  this,  unless  there  is  more  grave 
disease  than  I am  now  supposing  to  exist.  At  this 
age,  I use  the  syrup  of  tolu,  of  which  one-fourth  of  a 
teaspoonful  may  be  given  every  three  or  four  hours, 
in  a teaspoonful  of  water.  Occasionally  children 
take  it  more  readily  if  equal  parts  of  the  syrup  of 
tolu,  and  the  syrup  of  wild  cherry  bark  (prunus 
virginiana),  are  mixed  together,  a fourth  of  a tea- 
spoonful  of  this  mixture  being  given  every  two  or 
three  hours.  When  the  child  is  older,  say  three,  but 
under  six  months,  I use,  as  I have  said,  the  syrup  of 
ipecacuanha,  but  of  this  only  three  to  five  drops  in 
a teaspoonful  of  water,  once  in  three  or  four  hours. 
From  the  sixth  to  the  twelfth  month,  from  five  to 
twelve  drops  may  be  given,  and  during  the  second 
year  from  a fourth  to  a half  of  a teaspoonful.  Small 
as  these  doses  are,  I have  frequently  seen  them  make 
a child  vomit,  and  the  rule  should  always  be  (remem- 


166  OP  PARTICULAR  SYMPTOMS. 


Brown  mixture.  Its  composition  and  dose. 

ber,  I am  speaking  of  an  ordinary  slight  cold),  when 
one  dose  does  this,  to  let  a longer  interval  elapse 
before  the  next  dose,  which  should  also  be  decidedly 
smaller.  If  preferred,  the  ipecacuanha  may  be  given 
in  a half  of  a teaspoonful  of  the  syrup  of  tolu,  or 
of  the  combination  of  this  with  the  syrup  of  wild 
cherry. 

For  children  that  are  over  two  years  old,  I com- 
monly order  brown  mixture,  as  it  is  called — an  old- 
fashioned  prescription,  to  the  good  effects  of  which 
my  attention  was  called  by  one  of  my  instructors, 
while  I was  a medical  student,  and  which  I have 
used  with  a great  deal  of  satisfaction.  It  is  not 
what  is  termed  a very  elegant  preparation,  but  it  is 
what  is  far  better,  very  useful.  It  is  made  in  this 
way  : — Take  of  powdered  gum  arabic,  two  drachms  ; 
of  extract  of  liquorice,  two  drachms  j boiling  water, 
four  fluid  ounces  (equal  to  one  gill).  Dissolve  the 
gum  arabic  and  liquorice  in  the  water,  and  add  of 
wine  of  antimony,  two  fluid  drachms  (equal  to  two 
teaspoonfuls),  and  of  laudanum,  twenty  drops.  The 
medicine  should  be  thoroughly  shaken  up  before  a 
dose  is  poured  out.  Of  this,  a half  of  a teaspoonful 
may  be  given  every  three  hours  to  a child  under 
four  years,  and  the  dose  may  be  increased  to  one 


OP  PARTICULAR  SYMPTOMS.  167 


Did  of  a child  that  has  a cold.  For  a severe  cold. 

teaspoonful  given  with  the  same  interval.  For  an 
older  child  a correspondingly  larger  dose  may  be 
given,  and  the  proper  quantity  may  be  judged  of 
from  the  fact  that  the  dose  for  an  adult  is  a table- 
spoonful. The  only  disadvantage  attending  this 
medicine  is  that  it  does  not  keep  well  in  a warm 
place.  On  this  account  it  is  not  desirable  to  make 
up  large  quantities  of  it  at  once. 

The  diet  of  a child  laboring  under  a cold,  whether 
there  is  cough  or  not,  should  be  rather  restricted, 
not  to  the  extent  of  starving  it,  but  it  should  be 
kept  a little  short  of  what  it  ordinarily  eats,  and  the 
difference  should  be  chiefly  made  in  the  most  stimu- 
lating parts  of  its  diet,  as  the  meat.  To  “ stuff  a 
cold  ” is  an  injurious,  though  a common  practice. 

I desire  it  to  be  distinctly  understood,  and  there- 
fore repeat,  that  the  advice  which  I have  thus  given, 
goes  upon  the  supposition  that  the  cold  is  not  a 
severe  one.  It  is  not  safe,  when  it  is  so,  to  do  with- 
out the  advice  of  a medical  man  called  to  see  the 
particular  case ; and  though  nothing  more  may  be 
necessary,  it  may  be  of  importance  that  the  most 
active  remedies  should  be  at  once  resorted  to,  and 
of  the  moment  for  this  the  mother  -cannot  always 
judge. 


168  OF  PARTICULAR  SYMPTOMS. 


Whooping  cough.  Its  treatment.  Its  characteristics. 

The  different  seats  of  the  diseases  which  may 
ca/use  coughs  have  been  spoken  of,  and  in  these  the 
coughs,  or  the  modes  of  breathing,  differ.  Whooping 
cough  is  one  of  the  most  common  varieties,  and  the 
one  which  is  most  frequently  treated  by  the  mother 
without  the  physician’s  advice.  Yet  this,  when  it  is 
severe,  ought  not  to  be  allowed  to  go  without  profes- 
sional attendance.  In  the  mild  cases,  the  medicines 
which  I have  just  advised  to  be  given  for  ordinary 
coughs  will  suffice,  and  I shall  not  venture  to  recom- 
mend more  powerful  remedies  in  a miscellaneous  way. 
It  is  not  possible  to  tell,  at  first,  whether  or  not  the 
attack  is  one  of  whooping  cough,  but  it  is  of  less 
importance  that  the  treatment  is  not  much  varied. 
If  there  has  been  suspected  exposure  to  it,  the 
proper  precaution  is  to  prevent,  if  possible,  the 
exposure  of  other  children  to  it,  by  keeping  the 
patient  away  from  them  j and  this,  whether  they  are 
of  the  same  family,  or  strangers  to  it.  The  distinc- 
tive mark  of  the  disease  is  that  from  which  it 
derives  its  name,  a loud  whoop  occurring  occasion- 
ally during  the  paroxysm.  It  seems  as  if  the  child 
coughed  till  it  could  no  longer  expel  air  from  its 
lungs,  and  then  filled  them  again  with  a long  inspi- 
ration, and  that,  during  the  passage  of  the  air 


OF  PARTICULAR  SYMPTOMS.  169 


The  cough  of  measles. 

inward,  it  makes  in  the  upper  part  of  the  windpipe 
the  noise  referred  to.  The  child  may  be  playing  as 
ordinarily,  when  suddenly  it  begins  to  cough,  driving 
the  air  out  and  not  taking  in  breath  again,  the 
cough  growing  shorter  and  quicker,  until  the  face 
may  look  quite  dark  colored ; and  then  comes  the 
long  inspiration,  of  which  I have  spoken,  with  the 
peculiar  whoop  ; and  this  may  or  may  not  be  fol- 
lowed by  the  cough  again,  that  in  its  turn  to  be 
succeeded  by  the  whoop. 

There  is  another  peculiar  cough  to  which  children 
are  subject,  and  which  it  is  well  to  recognize.  I 
mean  that  which  precedes  the  breaking  out  of  mea- 
sles. It  is  accompanied  by  a watering  of  the  eyes, 
which  look  reddish  and  almost  blood-shotten,  and 
are  filled  with  tears,  though  not  as  if  crying.  There 
is,  at  the  same  time,  a watery  discharge  from  the 
nose.  No  whoop  accompanies  the  cough,  which  is 
often  short,  but  not  repeated  like  that  which  I have 
just  described.  It  is  usually  described  as  ringing. 
It  is  somewhat  like  a hoarse  cough,  and  is  peculiar  ; 
when  once  heard  it  is  not  easily  forgotten,  but  can- 
not be  described  by  words. 

But  the  most  fearful  disease  which  is  known  by  a 
peculiar  cough  is  croup,  which  is  justly  a terror  to 


170 


OF  PARTICULAR  SYMPTOMS. 


The  peculiar  cough  of  croup.  Two  varieties  of  croup. 

mothers,  and  the  peculiar  symptom  of  which  no 
physician  can  hear  with  perfect  equanimity.  This 
cough  is  also  often  described  as  ringing,  but  it 
differs  entirely  from  that  of  measles.  Unlike 
whooping  cough,  the  sound  is  produced  when  the  air 
is  expelled,  not  when  it  is  inhaled,  and  it  is  repeated 
with  each  cough.  It  is  as  if  the  air  were  driven 
through  an  opening  rather  obstructed  by  a substance 
not  very  firm,  nor  very  loose.  It  has  not  the  rattle 
that  is  heard  when  the  windpipe  is  stopped  by  loose 
phlegm.  Perhaps  it  is  best  described  in  its  first 
stage  as  a loud,  sonorous,  barking  cough,  while  the 
inspiration,  though  not  accompanied  with  a loud 
noise,  is  as  if  the  air  were  drawn  through  a narrower 
opening.  In  fact,  the  child  often  feels  as  if  the  air 
did  not  enter  the  lungs  readily,  and  its  complaints 
are  to  this  effect.  Nothing  more  than  an  apparently 
ordinary  cold  usually  precedes  this  attack,  which 
may  come  on  suddenly,  often  without  being  antici- 
pated, and  during  the  night. 

Before  going  farther,  it  ought  to  be  distinctly 
stated,  that  there  are  two  varieties  of  croup,  one  of 
which  is  called  membranous  or  true  croup,  and  the 
other,  spasmodic  croup.  The  spasmodic  is  of  the  most 
frequent  occurrence,  and  fortunately  is  rarely  fatal 


OF  PARTICULAR  SYMPTOMS.  171 


Spasmodic  croup  rarely  fatal. 


The  membranous  is  of  much  more  rare  occurrence, 
but  is  often  fatal.  At  first  it  is  difficult  to  distin- 
guish between  them,  and  it  is  on  this  account  that  it 
is  wise  to  resort  to  the  advice  of  a physician  as  soon 
as  an  attack  commences.  The  mother  becomes  in 
time,  after  a repetition  of  attacks,  somewhat  accus- 
tomed to  treating  it,  and  the  fact  that  her  child  has 
had  spasmodic  croup,  makes  the  probability  greater 
that  any  subsequent  attack  is  of  the  same  class.  A 
severe  recurrence  of  the  disease  ought  not  to  be  tri- 
fled with,  for  it  is  possible  that  the  membranous  may 
have  succeeded  to  the  milder  form. 

It  will  now  be  evident  how  it  is  that  one  may 
speak  of  croup  as  an  exceedingly  alarming  disease, 
and  another  may  consider  it  a mere  trifle.  There 
may  be  found  physicians  who  will  boast  that  they 
always  cure  this  disease,  and  no  more  dread  to  meet 
it  than  they  do  to  visit  a friend.  It  has  happened 
to  me  to  hear  one  and  another  speak  of  almost 
every  grave  disease  in  this  way,  and  now  when  I 
hear  such  language,  the  conclusion  is  to  me  inevita- 
ble that  the  speaker  has  been  fortunate  in  the  class 
of  cases  which  have  fallen  to  his  charge,  and  has 
never  encountered  the  graver  forms  of  the  disease. 
I do  not  intend  to  be  understood  to  say  that  all 


172  OF  PARTICULAR  SYMPTOMS. 


What  physicians  cure  all  their  cases  of  croup.  Treatment  of  croup. 

treatment  is,  in  my  estimation,  equally  beneficial,  or 
equally  inert.  Much  depends  on  the  treatment,  and 
the  particular  course  which  is  pursued,  especially  in 
the  early  stages  of  the  disease.  But  with  regard  to 
croup,  one  may  say  very  truly  that  he  has  cured  all 
his  cases  of  the  disease,  because  he  has  never  had 
one  of  the  graver  variety.  The  man  who  has  never 
lost  a patient  sick  with  croup,  never  can  have  had 
but  a very  few  cases  of  the  membranous  form,  for 
statistics  throughout  the  world  show  that  a very 
large  proportion  of  cases  of  this  disease  terminate 
fatally.  To  this  digression  I have  given  way,  that  I 
may  put  mothers  on  their  guard  against  any  boast- 
ing pretender  with  whom  they  may  chance  to  meet, 
or  to  whom  over  zealous  friends  commend  them. 

When  a child  is  heard  to  cough  in  the  croupy 
mode,  which  I have  attempted  to  describe,  it  should 
be  kept  in  a warm  room  and  carefully  watched. 
If  the  cough  returns  repeatedly,  and  the  same 
sound  characterizes  it, — if  slight  fever  accompanies 
it,  and  more  or  less  restlessness, — an  emetic  can 
be  given.  This  does  not  require  to  be  an  exces- 
sive one,  but  quite  moderate,  free  vomiting  being 
what  is  wanted,  and  not  a continual  and  protracted 
retching.  The  dose  for  a young  child  should  of 


OF  PARTICULAR  SYMPTOMS.  173 


Ipecacuanha.  How  spasmodic  croup  passes  off. 

course  be  much  smaller  than  for  one  that  is  six  years 
old.  It  is  better  to  give  repeated  small  doses,  than 
one  large  one,  sufficient  to  act  very  powerfully.  The 
reason  is,  that  there  is  a great  difference  in  the  ease 
with  which  different  persons  are  brought  under  the 
influence  of  emetics,  and  it  is  much  easier  to  repeat 
doses  to  one  who  does  not  vomit  readily,  than  it  is 
to  put  a stop  to  excessive  vomiting,  when  it  has  been 
produced. 

To  a child  under  a year,  a quarter  of  a teaspoon- 
ful of  syrup  of  ipecacuanha  may  be  given,  and 
repeated  in  twenty  minutes  if  no  vomiting  occurs 
previously.  When  free  vomiting  has  been  produced, 
one-half  the  quantity  can  be  given  at  the  same  inter- 
val, so  as  to  keep  the  patient  slightly  nauseated, 
though  not  to  the  degree  of  vomiting.  A child  that 
is  very  robust  may  have,  instead  of  this,  the  same 
quantities  of  hive  syrup,  a preparation  which 
can  be  procured  of  any  druggist.  But  it  is  to  be 
remembered  that  this  is  much  more  powerful  and 
prostrating  than  ipecacuanha  and  to  be  used  with 
more  caution.  A child  that  is  between  one  and  two 
years  old,  may  have  a half  larger  doses  : a child  that 
is  a year  older,  may  have  double  the  doses  of  the  child 
under  one  /ear,  and  for  the  succeeding  years  the 
doses  may  be  proportionally  increased. 


174  OF  PARTICULAR  SYMPTOMS. 


The  after  treatment  of  spasmodic  croup. 

When  the  disease  is  spasmodic  croup,  the  effect  of 
vomiting  is  usually  to  loosen  the  cough  and  to 
restore  it  to  a more  natural  sound  ; when  this  is 
done  the  distress  is  removed.  This  variety  occurs 
most  frequently  in  the  night,  the  child  awaking 
from  its  sleep  to  cough,  or  even  coughing  without 
waking.  After  vomiting  has  occurred  and  the 
cough  has  ceased,  the  child  having,  of  course,  been 
roused  by  the  operation  of  the  medicine,  it  fre- 
quently falls  asleep,  and  may  pass  the  rest  of  the 
night  without  farther  trouble.  The  disease  is, 
however,  very  apt  to  recur  on  the  succeeding  night 
at  about  the  same  time,  and  this  should,  if  possible, 
be  prevented.  During  the  intervening  day  the 
patient  should  be  kept  from  taking  additional  cold, 
and  for  this  it  is  sometimes  desirable  to  keep  him  in 
a warm  room  throughout  the  whole  of  it,  adminis- 
tering the  proper  medicines  tending  to  the  same 
effect.  These  I shall  not  venture  to  speak  of,  for 
fear  that  some  one  may  rely  upon  them  when  it  is 
membranous  croup  that  is  present,  and  thus  the 
time  for  cure  may  be  allowed  to  pass  unimproved. 
The  directions  which  I have  given  are  not  to  be 
relied  upon  to  the  exclusion  of  a physician’s  advice, 
but,  as  I have  before  said,  that  should  be  immedi- 


OF  PARTICULAR  SYMPTOMS.  175 

If  the  child  is  liable  to  attacks  of  croup. 

ately  sought.  As  he  cannot  always  go  at  once,  the 
time  can  thus  be  occupied  to  the  best  advantage  till 
he  arrives,  when  his  directions  should  be  implicitly 
followed. 

A child  that  is  subject  to  attacks  of  spasmodic 
croup,  should  be  guarded  with  unusual  care  from  the 
changes  of  weather,  and  all  those  influences  which, 
by  observation,  are  found  to  precede  the  parox 
ysms.  I do  not  intend  to  be  understood  to  say 
that  he  should  be  constantly  kept  in  the  house,  or 
prevented  from  engaging  in  the  sports  of  his  age 
which  are  invigorating.  He  should,  however,  be 
more  scrupulously  protected  from  the  evening  air, 
and  his  clothing  should  be  more  carefully  arranged 
to  protect  his  chest,  and  in  general  to  keep  him  more 
constantly  warm. 

A child  that  has  had  one  attack  of  membranous 
croup,  should  be  still  more  carefully  defended  from 
all  these  influences.  There  is  no  advantage  in 
excessive  anxiety,  and  yet  a mother  must,  under  such 
circumstances,  feel  that  her  child’s  life  hangs  if  pos- 
sible, on  a more  slender  thread  than  that  which 
before  sustained  it.  The  happy  medium  is  here,  as 
always,  the  best ; neither  too  much  anxiety,  nor  too 
much  indifference. 


176  OF  PARTICULAR  SYMPTOMS. 


Other  coughs. 

There  are  several  other  diseases  which  are  accom- 
panied by  a cough,  but  they  are  for  the  most  part 
too  serious  for  the  mother  to  think  of  treating  them. 
Lung  fever  is  one  of  these,  the  cough  being  quite 
similar  in  its  tones  and  frequency  to  that  of  bron- 
chitis, which  is  the  disease  ordinarily  receiving  the 
name  of  a cold  on  the  lungs.  There  is,  however, 
much  more  fever,  loss  of  appetite,  and  general  con 
stitutional  disturbance.  It  is  a grave  disease,  and 
though  it  is  not  in  the  majority  of  cases  fatal,  it 
should  not  be  tampered  with.  Pleurisy  is  another 
of  the  diseases  which  is  attended  by  a cough,  but 
it  causes  a high  fever.  The  cough  is  more  sup- 
pressed than  in  lung  fever,  and  when  a full  breath  is 
taken  in,  there  is  a catch  at  a certain  point,  as  if  a 
sharp  pain  shot  through  the  chest,  which  is  indeed 
the  case.  The  disease  is  not  a common  on£  in  chil- 
dren, and  when  it  does  occur  a physician  should 
treat  it. 


OF  THE  SICK  ROOM. 


177 


Attention  to  this  subject  neeessary. 


Chapter  XI, 

THE  MANAGEMENT  OF  THE  SICK  ROOM. 

Some  observations  upon  this  topic  cannot  be  mis^ 
placed,  for  much  suffering  may  be  caused  by  the 
ignorance  of  mothers  concerning  it.  When  an 
adult  is  sick,  the  expression  of  his  feelings,  which  he 
is  able  to  give,  causes  his  attendants  to  take  proper 
precautions  against  annoyances.  But  the  young 
child  is  either  unable  to  talk  or  to  make  known  his 
troubles,  or,  as  is  frequently  the  case,  his  troubles  are 
thought  to  be  whimsical,  and  unworthy  of  consider- 
ation. Still,  the  arrangement  and  management  of 
the  sick  room  are  often  of  more  importance  to  the 
child,  than  they  are  to  the  grown  person. 

A child  that  is  slightly  unwell  does  not  require  to 
be  shut  up  in  a separate  room,  or  to  be  deprived  of 
ts  ordinary  occupations.  Still,  it  should  be  some 
12 


178 


THE  MANAGEMENT 


Indulging  inclinations.  Selection  of  a room  for  the  patient. 

what  humored  in  its  languor,  and  allowed,  if  it 
inclines  to  do  so,  to  lie  upon  its  bed,  or  to  lounge 
upon  the  sofa,  or  to  keep  entirely  quiet.  A child 
that  has  had  an  attack  of  croup,  more  particularly 
of  spasmodic  croup  at  night,  will  be  too  much  dis- 
posed to  play  in  his  usual  way,  and  it  is  necessary  to 
restrain  him  somewhat  by  keeping  in  a warm  room, 
and  occupying  his  attention  by  more  quiet  amuse- 
ments than  his  ordinary  ones.  A child  that  has  a 
diarrhoea  will  also  sometimes  be  inclined  to  too  great 
activity,  as  well  as  to  eat  and  drink  too  much,  and 
therefore  must  be  kept  still  as  well  as  dieted 
carefully. 

But  it  is  more  particularly  of  the  care  of  children 
that  are  suffering  from  disease,  to  such  an  extent  as 
requires  them  to  be  confined  to  bed  most  of  the 
time,  that  I now  speak  ; that  is,  when  their  apart- 
ment can  properly  be  called  a sick  room. 

When  a child  is  attacked  with  such  illness  as 
seems  likely  to  be  of  some  days  duration,  the  most 
airy,  comfortable,  and  quiet  room  under  the  mother’s 
control  should  be  assigned  to  it.  If  the  nursery  is 
such  a place,  and  there  are  not  any  other  children  to 
occupy  it,  it  is  better  not  to  change  from  it,  as  the 
child  is  not  distracted  or  alarmed  by  the  newness  of 


OP  THE  SICK  ROOM. 


179 


Quiet  necessary.  Various  annoyances. 

the  objects  about  it.  But  if  there  are  other  children 
in  the  family,  they  should  be  moved  to  another  room 
or  the  patient  should  be  so  transferred  — which 
should  go,  depending  often  on  the  advantages  which 
the  second  apartment  presents  for  the  purposes  of  an 
invalid.  It  is  in  this  way  that  quiet  is  in  a measure 
secured.  Every  one  who  has  been  sick,  knows  how 
desirable  it  is  to  be  quiet,  and  how  often  noise,  bus- 
tle, and  confusion  in  the  room  seem  to  cause  more 
than  half  of  the  suffering.  But  there  are  some 
other  precautions  to  be  taken,  in  order  that  the  same 
end  may  be  secured.  These  depend  on  the  mother 
and  nurse,  or  whoever  may  be  in  attendance  upon 
the  patient.  The  sick  child  is  often  annoyed  by  the 
rustling  of  garments,  by  the  squeaking  of  shoes,  and 
by  the  constant  movements  of  those  who  are  about 
it.  A silk  gown  is  not  a fit  thing  for  such  an  occa- 
sion, for  this,  if  for  no  other  reason,  and  soft  slip- 
pers in  which  one  can  glide  about  without  noise  are 
indispensable.  When  the  child  lies  quiet,  as  if 
attempting  to  sleep,  the  occupation  of  the  mother,  or 
nurse,  should  be  such  as  to  make  no  noise.  Even 
sewing,  especially  on  some  kinds  of  stuff,  gives  very 
great  annoyance,  while  the  turning  of  a newspaper 
will  startle  one  almost  like  thunder.  Conversation 


m 


180 


THE  MANAGEMENT 


Light.  Ventilation. 

at  such  times  should  be  abstained  from,  but  if  neces- 
sary should  be  in  a low,  natural  voice,  not  in 
whispers. 

Beside  securing  quiet,  it  is  often  desirable  to  shut 
out  the  light  to  a certain  extent,  but  not  entirely. 
The  glare  of  the  sun  in  Summer  should  be  softened 
by  closing  the  blinds,  by  drawing  down  the  shades, 
or  dropping  the  curtains.  This  is  to  be  done  when 
the  child  is  annoyed  by  the  light,  as  is  often  the 
case — headache  being  produced  or  increased  by  it. 
So  it  is  in  fevers,  when  the  stimulus  of  the  light  adds 
to  the  child’s  discomfort.  But  in  diseases  which  last 
a long  time,  reducing  the  strength  of  the  patient 
(such  as  diarrhoeas),  and  when  the  patient  is  conva- 
lescent, it  is  often  desirable  that  it  should  be  exposed 
freely  to  the  light.  Judgment  and  common  sense 
are  requisites  in  this,  as  in  so  many  other  cases,  but 
it  may  be  proper  to  suggest  that  the  good  of  the 
patient  should  always  be  the  first  and  most  impor- 
tant consideration  in  the  sick  room.  Every  one’s 
comfort  and  convenience  should  yield  to  that. 

Yentilation  should  be  scrupulously  arranged,  with 
the  restrictions  as  to  the  exposure  of  the  invalid 
that  I have  before  spoken  of  as  being  necessary  in 
the  sleeping  apartment  during  health.  The  impor- 


OF  THE  SICK  ROOM. 


181 


Removal  of  odors. 

tance  of  a constant  supply  of  pure  fresh  air  is,  if 
possible,  greater  to  the  invalid  than  it  is  to  the 
healthy  child.  To  shut  children  with  such  diseases 
as  small  pox,  or  measles,  or  scarlet  fever,  in  a small 
or  close  room,  is  quite  sure  to  aggravate  the  disease, 
and  to  expose  the  child’s  life  to  still  greater  risks. 
All  of  the  diseases,  however,  which  are  attended 
with  much  feverishness,  require  that  the  child  should 
be  guarded  against  taking  cold  by  draughts  of  air 
blowing  upon  any  part  that,  in  the  restlessness  of 
fever,  may  have  become  exposed.  During  Summer 
the  windows  may  be  freely  opened  if,  by  so  doing,  it 
is  not  necessary  to  let  in  too  much  light  and  noise, 
and  during  both  day  and  night  at  colder  seasons,  a 
window  slightly  opened  will  often  give  increased 
freshness  to  the  air. 

The  sick  room  should  be  kept  as  free  as  possible 
of  all  odors.  This  cannot  be  done  unless  great  care 
is  taken.  It  is  necessary  to  remove,  at  once,  all  such 
matters  as  have  been  vomited  or  may  have  passed 
from  the  bowels,  and  for  this  purpose  it  is  sometimes 
desirable  to  change  the  clothing,  if  that  has  become 
soiled.  When  a child  is  extremely  prostrated,  it 
will  not  answer  to  raise  him  up  for  sufficient  time  to 
do  this,  for  he  may  be  unequal  to  the  fatigue  of  it. 


182 


THE  MANAGEMENT 


Preparation  of  food. 

But  in  that  case  he  should  be  kept  dry  by  placing 
napkins  between  him  and  the  damp  clothes,  and  by 
taking  care  to  remove  all  of  the  bed  clothes  that  can 
be  changed  without  disturbing  him.  Cooking 
should  not  be  done  in  the  sick  room,  if  it  can  be 
avoided,  and  all  the  preparation  of  the  patient’s 
meals  had  better  be  done  out  of  his  sight. 

So  also  with  regard  to  the  medicines  ; preparing 
them  had  better  be  done  away  from  the  patient, 
they  being  brought  to  him  when  ready  to  be  taken. 
The  bottles,  or  boxes,  in  which  they  are  contained 
had  also  better  be  kept  in  another  room.  To  see  a 
dose  mixed,  and  to  know  that  it  is  coming,  leads,  by 
the  very  anticipation  of  it,  to  a determination  not  to 
take  it,  or  produces  a nausea  which  even  more  effect- 
ually prevents  one  from  swallowing  it. 

When,  notwithstanding  the  immediate  removal  of 
discharges  from  the  sick  room,  the  air  has  become 
tainted,  several  substances  may  be  used  to  conceal 
the  unpleasant  odor,  until  a renewed  supply  of  fresh 
air  has  replaced  it.  For  this  purpose,  the  usual 
homely  methods  are  burning  a little  sugar  on  an 
open  pan  of  coals,  or  on  a hot  shovel ; burning  a 
piece  of  brown  paper  and  allowing  it  to  smoke ; or 
filling  the  room  with  the  odor  of  coffee  roasting,  or 


OF  THE  SICK  ROOM. 


183 


Concealing  odors  does  not  purify  the  air.  Unpleasantness  of  medicines. 

using  some  of  the  perfumed  pastilles  designed  for 
that  purpose.  It  should  be  remembered,  however, 
that  none  of  these  methods  purify  the  air.  They 
simply  substitute  a pleasant  odor  for  one  that  is  dis- 
agreeable, and  should  not  be  depended  on  for  any 
other  purpose.  Fresh  air  substituted  for  the  tainted, 
is  the  only  certain  mode  of  purification,  which  is  of 
sufficiently  easy  adoption  to  be  of  general  use. 

To  get  a child  to  take  medicines  is  quite  a diffi- 
cult thing,  if  they  are  disagreeable  to  the  taste. 
Very  young  children  cannot  swallow  pills,  and  a 
liquid,  or  a powder  that  tastes  unpleasantly  is  often 
spit  out  with  wonderful  promptness.  On  this 
account,  especial  attention  has  to  be  given  by  physi- 
cians to  the  composition  of  medicines  intended  to  be 
administered  to  children.  It  is,  in  fact,  quite  an  art  of 
itself,  from  neglect  of  which  ill-success  often  attends 
the  otherwise  well  directed  efforts.  Some  children 
will  readily  take  medicines  if  they  are  given  in 
pleasant  syrups,  while  others  will  take  them  better 
if  administered  as  powders,  mixed  with  a little  pul- 
verized sugar.  At  other  times,  it  is  advised  to  mix 
the  medicine  with  the  child’s  food,  especially  if  it  is 
old  enough  to  eat,  on  the  supposition  that  it  will  be 
swallowed  unobserved.  To  this  last  method,  there 


184 


THE  MANAGEMENT 


Of  concealing  medicines  in  food . How  to  give  pmuders. 

is  in  my  mind  a grave  objection,  from  the  fact  that 
a sick  child  is  apt  enough  to  become  disgusted  with 
its  food,  not  to  have  that  possibility  increased  by  the 
addition  of  nauseous  doses.  A disgust  thus  taken  is 
sometimes  permanent,  and  is  injurious  from  shutting 
the  child  out  from  an  otherwise  desirable  article  of 
diet.  Much  must  depend  on  the  physician  in  his 
selection  of  preparations,  and  a suggestion  from  the 
mother  as  to  what  class  of  preparations  are  particu- 
larly unpleasant  to  the  child,  is  often  of  great 
service  to  him.  He  should  always  give  precise 
directions  as  to  the  mode  of  administering  the  med- 
icine, the  dose,  and  the  vehicle.  But  when  this  is 
not  done,  the  mother  may  be  assisted  by  remember- 
ing these  general  directions.  To  children  that  are 
very  fond  of  syrups,  many  kinds  of  liquid  medicines, 
and  of  powders,  may  be  given  in  syrups,  aud  the 
simpler  the  better.  In  almost  all  cases,  except  when 
there  is  diarrhoea,  even  the  ordinary  molasses  may 
be  used,  and  should  the  child  become  disgusted  with 
it,  no  harm  is  done.  Powders  may  be  given  with 
sugar  which  is  very  finely  pulverized,  there  being  a 
large  proportion  of  sugar  to  the  medicine.  The 
granulated  sugar  will  not  answer  so  well,  not  being 
so  readily  dissolved,  and  the  taste  of  the  medicine 


OP  THE  SICK  ROOM. 


185 


Homo  to  give  liquids. 

will  precede  the  taste  of  the  sugar  — precisely  what 
is  not  wanted.  If  the  medicine  is  liquid,  and  the 
taste  of  it  is  not  very  marked,  but  the  child  objects 
to  it  because  it  is  known  to  be  medicine,  the  diffi- 
culty may  be  overcome  by  dropping  it  on  a piece  of 
sugar,  and  letting  the  child  take  that. 

Another  convenient  mode  of  giving  liquids  is  to 
administer  them  in  some  kind  of  herb  tea  which  has 
a decided  flavor.  Thus  teas  may  be  made  of  the 
ordinary  strength,  from  caraway  or  anise  seed,  and 
the  liquid  can  be  dropped  into  a little  of  this.  Any 
other  fragrant  herb  may  be  used  that  is  commonly 
administered  to  children.  Or,  if  this  is  not  conven- 
iently done,  a small  piece  of  candy  that  has  a 
decided  flavor,  as  peppermint,  may  be  dissolved  in 
water,  and  this  can  be  used  in  the  same  way.  Pow- 
dered candy  can  also  be  used  to  conceal  the  taste  of 
pulverized  medicines  when  it  cannot  be  done  by 
simple  sugar. 

But  there  are  some  medicines  which  it  may  be 
necessary  to  give  and  which  admit  of  no  disguise. 
Castor  oil  is  one  of  these,  and  although  it  is  now 
carefully  refined  and  thus  deprived  of  much  of  its 
former  disagreeable  taste,  it  still  remains  castor  oil. 
The  instances  are  rare  in  which  this  is  not  com- 


186 


THE  MANAGEMENT 


How  to  give  castor  oil. 

pletely  disgusting,  though  I did  know  one  medical 
student  who  was  as  fond  of  castor  oil  as  he  was  of 
honey,  and  would  take  it  for  its  delicate,  and  to  him 
pleasant  flavor.  But  so  I have  known  one  of  my 
relatives,  when  a boy,  to  prefer  saleratus  to  sugar. 
These  are,  however,  very  exceptional  cases.  After 
trying  almost  every  thing  which  has  been  recom- 
mended for  the  purpose,  I conclude  that  this  medicine 
admits  of  no  concealment.  To  give  it  in  milk  is 
cruel,  for  milk  will  for  a long  time  after,  have  a 
suspicious  taste.  I can  suggest  no  better  method 
than  to  use  no  coaxing  about  the  matter,  but  to 
assure  the  child,  if  old  enough  to  understand,  that  it 
is  not  a question  whether  or  not  he  will  take  it,  but 
that  it  is  to  be  taken,  and  if  well  done  a reward  of 
a bit  of  fragrant  candy,  or  other  delicacy  having  a 
decided  flavor,  is  to  follow.  With  very  young  infants 
it  is  to  be  put  in  the  mouth,  and  if  it  is  not  swal- 
lowed, the  nose  may  be  held  a few  minutes  when  it, 
probably  will  be.  It  should  always  be  warmed 
before  it  is  given,  for  then  it  becomes  thinner  and  is 
more  easily  swallowed.  But  I confess,  that  with  me 
this  is  not  a favorite  prescription,  especially  for  chil- 
dren, and  I do  not  give  it  so  long  as  anything  else 
will  answer  the  purpose,  which  is  not  always  the  case. 


OF  THE  SICK  ROOM. 


187 


Injections.  Their  use. 

Another  difficult  way  of  giving  medicines  (for  it 
is  a method  of  doing  this,  if  only  cold  water  is  used), 
is  by  injection,  unless  it  is  well  understood,  and 
then  it  is  quite  easy.  Yery  little  force  is  necessary, 
in  fact  almost  none,  except  to  hold  the  child  still. 
Injections  are  so  important  a matter  that  I shall 
somewhat  fully  describe  the  method  of  giving  them. 

It  should  be  remembered  that  they  are  given  to 
children  chiefly  for  two  purposes,  and  these  are 
entirely  different.  One  design  in  using  them,  is  to 
procure  an  evacuation  of  the  contents  of  the  bowels. 
Another  is  to  stop  the  movements  of  the  bowels, 
which  have  become  too  frequent,  or  too  profuse. 
Now  the  general  mode  of  giving  an  injection  is  the 
same,  but  the  ingredients  and  the  quantities  differ 
exceedingly.  To  move  the  bowels  when  constipated, 
a large  quantity  of  fluid  is  necessary  ; to  check  their 
movements,  as  little  as  will  answer  the  purpose  of 
conveying  the  drug  which  is  to  do  the  real  service. 
On  the  latter  class  of  injections  and  their  ingre- 
dients, I shall  not  dwell,  because  when  needed,  the 
child  is  too  sick  for  the  mother  to  take  the  responsi- 
bility of  treating  it,  and  the  physician  in  attendance 
will  give  all  necessary  directions  concerning  these 
things.  The  drug  is,  in  such  cases,  usually  directed 


188 


THE  MANAGEMENT 


Injections  in  dysentery . In  constipation. 

to  be  given  in  starch.  For  this  purpose  it  should  be 
quite  thick,  and  one  or  two  teaspoonfuls  is  all  that 
should  be  thrown  into  the  bowel.  As  soon  as  the 
pipe  of  the  syringe  is  withdrawn,  a diaper  should  be 
pressed  against  the  parts,  to  prevent  the  immediate 
expulsion  of  the  fluid.  The  patient  should  then  be 
permitted  to  lie  quite  still,  especial  pains  bging  taken 
to  prevent  him  from  sitting  up. 

To  move  the  bowels  by  injections  when  consti- 
pated, a much  larger  quantity  of  fluid  and  of  a 
different  character,  is  needed.  Instead  of  being 
thick,  bland,  and  unirritating,  it  often  requires  to  be 
exactly  the  reverse  of  all  these.  The  mildest  injec- 
tion for  this  purpose  is  tepid  water,  and  of  this  the 
quantity  varies  according  to  the  age  of  the  child. 
A gill  is  enough  for  an  infant  during  the  first  six 
months,  and  even  less  may  be  used  at  the  first  part 
of  this  period.  Twice  this  quantity  may  be  required 
after  the  first  six  months,  though  it  is  not  always 
necessary  to  thus  increase  it. 

When  this  simple  remedy  does  not  suffice  to  accom- 
plish the  desired  purpose,  it  is  well  to  add  a half 
teaspoonful,  or  even  a teaspoonful  of  sweet  oil  to  it. 
When  this  is  done,  the  oil,  of  course,  floats  upon  the 
water,  and  the  precaution  must  be  taken  to  hold  the 


OP  THE  SICK  ROOM. 


189 


On  adding  oil  ana  moiasseb.  Soap  injections. 

end  of  the  pipe  near  the  surface  in  filling  the 
syringe,  if  it  is  intended  to  use  the  oil. 

A little  molasses,  say  one  or  two  teaspoonfuls,  is 
with  some,  a favorite  addition  to  increase  slightly 
the  activity  of  the  injection.  I cannot  say  that  I 
like  it  very  well,  but  it  can  be  borne  in  mind.  The 
coarser  the  molasses  the  better  is  it  fitted  for  this 
use. 

Soap  is  a very  common  and  good  addition  to  the 
water,  and  by  selecting  different  varieties,  and  using 
them  in  different  quantities,  the  strength  of*  the 
injection  can  be  varied  to  any  desirable  extent.  For 
young  children,  only  a very  small  proportion  of  soap, 
and  that  of  a mild  character,  like  palm  oil,  or  old 
castile  soap,  should  be  used.  Too  irritating  injec- 
tions are  injurious,  so  that  the  rule  should  be,  not  to 
keep  the  strength  greater  than  is  required,  but 
rather  less  than  may  be  thought  to  be  necessary. 
Soap  irritates  much  more  than  oil,  so  that  I fre- 
quently prefer  the  latter. 

Other  injections  are  used,  but  usually  only  under 
the  directions  of  a physician,  who  can  be  consulted 
as  to  their  preparation.  Those  which  I mention, 
are  the  common  ones  of  the  nursery. 

But  supposing  the  kind  of  injection  to  be  settled, 


190 


THE  MANAGEMENT 


Syringes.  The  best  size  of  the  common  syringe.  Filling  the  syringe. 

the  question  arises  by  what  means,  and  in  what  way, 
is  it  to  be  given.  The  instrument  to  be  used  is 
called  a syringe,  and  there  are  many  varieties  of  it. 
Most  of  them  are  arranged  on  one  of  two  principles, 
and  by  speaking  of  the  class,  the  purpose  will  be 
answered.  The  most  common  instrument  in  use,  is 
the  pewter  syringe,  which  has  a short  pipe,  and  a 
piston  forced  down  directly  in  the  barrel  to  which 
the  pipe  is  applied.  In  size  they  vary  from  holding 
an  ounce  to  holding  a quart,  but  all  act  on  the  same 
plan.  For  use  in  checking  a diarrhoea,  the  smallest 
size  is  all  that  is  needed,  but  a large  one  when  the 
bowels  are  to  be  moved.  For  a child  under  four 
years,  a four  ounce  syringe  is  about  the  most  con- 
venient size,  though  a larger  one  may  be  better  at 
the  last  part  of  this  time.  The  four  ounce  syringes 
can,  however,  be  worked  with  one  hand,  which  is 
often  quite  an  advantage.  The  piston  of  a good 
syringe  works  uniformly,  smoothly,  and  steadily, 
when  drawn  up  and  pushed  down  in  the  tube,  and 
this  should  be  looked  at  in  selecting  an  instrument. 
The  pipe  should  be  smoothly  rounded,  and  without 
sharp  edges  or  roughness. 

The  fluid  to  be  injected  being  decided  upon,  and 
made  about  milk  warm,  the  next  thing  is,  to  fill  the 


OF  THE  SICK  ROOM. 


191 


How  to  give  an  injection. 

syringe.  This  is  done  by  putting  the  pipe  below  the 
surface  of  the  fluid,  and  then  drawing  up  the  piston. 
It  is  wise  to  push  this  thoroughly  down  after  it  is 
first  drawn  up,  and  then  draw  it  up  again.  Much  of 
the  air  is  thus  expelled,  and  the  metal  of  the  syringe 
is  also  warmed.  Then  reversing  the  position  of  the 
syringe  and  holding  the  pipe  up,  push  the  piston 
gently  till  the  fluid  begins  to  appear  at  the  end  of 
the  pipe,  thus  showing  that  the  air  has  all  been 
expelled,  for  it  is  not  desirable  to  force  this  into  the 
bowel. 

While  the  mother  holds  the  syringe,  the  nurse  can 
put  the  child  into  position  for  receiving  the  injection, 
— the  most  convenient  one  being  with  the  child 
lying  upon  its  back  in  her  lap.  The  mother  having 
oiled  the  pipe  of  the  syringe,  may  then  pass  it  into  the 
bowel,  holding  the  syringe  with  one  hand  so  firmly 
that  there  is  no  danger  of  its  being  dropped,  and 
with  the  other  draw  the  parts  slightly  tense.  As 
the  pipe  is  pressed  into  the  bowel,  it  should  be  with 
great  gentleness,  and  a slight  rotary  motion  may  be 
given  to  it  at  the  same  time.  It  should  not  be  car- 
ried directly  up  on  the  middle  line  of  the  body,  but 
the  end  of  the  pipe  should  be  slightly  inclined  to 
the  left  side  of  the  child.  As  soon  as  the  pipe  is 


192 


THE  MANAGEMENT 


Cooling  applications  to  the  head. 

fairly  inserted,  the  piston  of  the  syringe  should  be 
pushed  down  with  one  hand,  while  the  other  holding 
the  body  of  the  instrument  prevents  it  from  pressing 
too  hard  against  the  bowels.  If  the  child  strains 
and  presses  down,  a moment  should  be  seized  when 
he  is  not  doing  so,  for  thus  the  fluid  will  pass  farther 
into  the  bowel.  The  syringe  should  be  withdrawn 
immediately  after  the  injection  has  been  thrown  in, 
and  a dry  diaper  should  be  firmly  pressed  against 
the  parts  to  retain  the  injection  for  a few  minutes. 
If  more  than  one  syringe  full  is  to  be  given,  the 
same  process  is  to  be  repeated,  but  as  I have  already 
observed,  it  is  better,  if  possible,  to  use  an  instru- 
ment sufficiently  large  to  require  but  one  filling. 
The  child  may  be  kept  on  his  back  for  a little  time 
and  then  be  allowed  to  sit  up,  when  the  injection 
will  probably  be  discharged. 

When  a child’s  head  is  hot  it  is  necessary  to  make 
cool  applications  to  it,  and  some  little  art  is  required 
not  to  do  more  harm  than  good  with  them.  There 
are  several  ways  of  applying  them,  sometimes  one 
and  sometimes  another,  is  preferable.  The  common 
method,  which  is  a very  good  one  in  several  respects, 
is  simply  to  place  wet  cloths  upon  the  forehead  and 
top  of  the  head,  replacing  them  when  they  have 


OF  THE  SICK  ROOM. 


193 


Wet  cloths.  Ice  in  cloths. 

become  warm.  When  this  is  done,  the  precaution 
should  be  taken  to  wring  the  cloth  thoroughly  before 
putting  it  on  the  child’s  head,  so  that  there  may  not 
be  sufficient  water  in  it  to  run  down  upon  the  bed 
and  wet  it.  Of  course  this  requires  a frequent 
renewal  of  the  cloths,  and  is  quite  sufficient  to 
occupy  one’s  time  constantly.  In  changing  the 
cloths  it  should  not  be  done  too  abruptly,  for  fear 
that  the  shock  will  startle  the  child  too  much.  Like 
everything  else  done  to  a sick  child,  very  great  gen- 
tleness should  accompany  it. 

When  a more  constant  temperature  is  desired,  or 
when  it  is  not  possible  for  one  to  sit  by  the  child  to 
renew  the  cloths  so  regularly  as  ought  to  be  done, 
ice  may  be  used.  It  will  not  answer,  however,  to 
apply  this  directly  to  the  surface,  for  only  one  spot 
would  be  thoroughly  cooled,  and  in  that  there  would 
be  some  danger  of  producing  the  death  of  it  by 
freezing,  so  that,  after  the  child  had  recovered  from 
the  disease  for  which  the  ice  was  applied,  he  might 
die  of  the  injury  done  by  the  ice..  The  method 
which  is  usually  most  convenient  is,  to  lay  upon  the 
forehead  a napkin  folded,  and  including  between  its 
thicknesses  a lump  of:  ice  as  large  as  a goose’s  egg, 
or  two  or  three  smaller  pieces.  The  side  next  the 
13 


194 


THE  MANAGEMENT 


Ice  in  bladders . 

head  should  be  wet  at  first,  and  then  the  heat  of  the 
head  serves  to  dissolve  the  ice,  while  the  dissolving 
ice  serves  to  keep  the  head  cool.  When  the  piece 
first  applied  has  all  gone,  another  napkin  can 
replace  the  first,  including  a piece  of  ice  as  before, 
while  the  first  is  dried.  In  this  way,  changing  the 
napkins  with  every  new  application,  much  less  water 
runs  down  upon  the  bed  and  night  clothes  of  the 
child.  Still  farther  to  guard  these,  additional  nap- 
kins may  be  placed  at  each  end  of  the  one  which 
lies  upon  the  head  and  contains  the  ice,  so  that  as 
the  water  runs  down,  it  may  be  absorbed  by  them 
instead  of  wetting  the  bed  clothes. 

But  a still  better  way  is,  to  fill  bladders  with  very 
cold  water,  or  with  finely  pounded  ice,  not  to  disten- 
sion, but  so  that  they  are  half  full.  The  opening 
should  then  be  carefully  closed  by  a string,  tied 
round  it  so  tight  that  there  can  be  no  leakage. 
Each  should  be  wrapped  in  a large  napkin,  and  one 
or  two  may  be  used  at  the  same  time.  If  two  are 
used,  one  napkin  should  be  pinned  to  the  pillow  so 
as  to  hold  the  bladder  to  the  back  of  the  head,  or 
rather  so  that  the  head  may  rest  upon  it.  The  other 
may  be  allowed  to  lie  upon  the  head,  a corner  of 
this  napkin  being  also  pinned  to  the  pillow.  There 


OF  THE  SICK  ROOM. 


195 


Amusement  of  sick  children.  diving  food  during  sickness. 

is,  in  this  way,  much  less  danger  of  the  pillow  and 
bedclothes  becoming  wet.  Instead  of  the  bladders, 
bags  of  thin  india-rubber  may  be  used,  and  are,  of 
course,  drier  than  bladders. 

It  is  worth  while  to  add,  that  in  the  sick  room  of 
the  child  cheerfulness  is  indispensable  to  the  nurse. 
A bright  and  cheerful  face,  but  quiet  and  soothing 
manner,  are  great  comforts  to  the  invalid,  and 
remove  much  of  the  irritation  to  which  children,  as 
well  as  adults,  are  subject.  Sick  children  are  to  be 
amused  by  stories  narrated  in  a quiet  tone,  by  their 
most  unexciting  plays  and  playthings,  or  in  some 
other  gentle  way,  so  as  to  while  away  the  long  days 
of  illness.  Attention  to  these  little  things  makes 
the  difference  between  a good  or  an  indifferent 
nurse,  and  the  mother  should  bear  them  in  mind, 
that  she  may  be  able  to  do  everything  that  is  best 
for  the  child. 

During  sickness  the  propriety  of  giving  food,  or 
of  withholding  it,  depends  upon  the  character  of 
the  disease,  and  no  rules  can  be  given  which  will  be 
sure  to  suit  every  case.  The  opinion  of  the  medical 
attendant  should  therefore  be  asked,  not  only  as  to 
the  articles  of  diet  which  it  is  most  desirable  for  the 
patient  to  take,  but  as  to  the  quantities.  At  some 


196 


THE  MANAGEMENT 


Sometimes  the  stomach  must  rest. 

times  it  is  necessary  to  give  very  small  quantities, 
perhaps  not  more  than  a half  teaspoonful  at  a time, 
but  this  requires  to  be  frequently  repeated,  and  to 
be  given  icy  cold.  It  is  in  cases  in  which  there  has 
been  very  great  vomiting,  or  tendency  to  it,  that 
this  is  required.  In  other  cases  hot  drinks  are 
required,  and  in  larger  quantities  with  longer  inter- 
vals. The  directions  of  the  physician  in  this,  as 
well  as  all  other  respects,  should  be  followed  by  the 
mother  if  she  has  sufficient  confidence  in  him  to 
trust  the  child’s  life  to  his  care.  One  thing,  how- 
ever, is  of  great  importance  to  be  known  to  the 
mother,  and  that  is,  that  the  child  who  is  attacked 
by  a disease  in  which  the  fever  runs  very  high,  does 
not  want  to  eat  and  does  not  need  to.  In  fact,  it  is 
better  that  the  stomach  should  be  allowed  to  rest — 
little  more  than  cold  water  being  given  -r-  rather 
than  to  be  crowded  with  substances  which  it  cannot 
digest.  For  two  or  three  days  after  a severe  fever 
commences,  food  forced  into  the  stomach  will  only 
increase  the  heat,  and  restlessness,  and  headache  of 
the  patient,  doing  not  only  no  good,  but  absolute 
harm.  The  common  idea  that  something  must  be 
eaten  after  the  lapse  of  a certain  time,  whether  the 
child  is  sick  or  well,  is  a mistaken  notion.  In  this 


OP  THE  SICK  ROOM 


197 


Stimulants  sometimes  necessary. 

class  of  diseases,  therefore,  the  mother  should  not 
force  food  upon  the  child.  It  is,  of  course,  in  a 
condition  which  justifies  anxiety  on  her  part,  but 
feeding  will  not  remove  the  disease.  At  other  times 
it  is  necessary  to  force  food  into  the  stomach,  but 
this  is  chiefly  in  cases  of  extreme  prostration,  not  of 
high  fever,  and  it  is  then,  strictly  speaking,  some 
stimulant  rather  than  food  that  is  to  be  given.  In 
these  cases,  it  is  as  necessary  to  be  particular  to  give 
the  wine  whey,  or  milk  punch,  or  whatever  else  is 
ordered,  as  it  is,  in  the  other  case,  to  refrain  from 
giving  even  milk,  water,  or  gruel. 


198 


OP  EMERGENCIES. 


These  require  prompt  action  of  the  mother.  Convulsions  or  Jits. 


Chapter  XII. 

OF  EMERGENCIES. 

There  are  various  emergencies  that  may  arise, 
and  demand  immediate  action  from  whoever  may  be 
present,  in  order  to  save  the  life  of  the  child,  or 
that  no  time  may  be  lost  in  waiting  till  the  physi- 
cian arrives.  In  this  chapter  I have  grouped  several 
of  them  together,  believing  that  the  information  may 
be  of  value.  Some  of  these  arise  from  accidents 
which  may  occur  at  any  moment,  and  others  from 
the  health  of  the  child,  depending  upon  internal, 
instead  of  external  influences. 

One  of  the  most  common,  as  well  as  most  startling 
of  these  emergencies,  is  the  occurrence  of  a fit  or 
convulsion — these  being  synonymous  terms — which 
may  happen  to  a child  that  is  apparently  perfectly 
well,  or  may  occur  in  the  course  of  various  diseases. 


OF  EMERGENCIES. 


199 


How  they  may  be  produced.  Distinctions  between  different  words. 

It  is  always  startling,  but  it  is  a relief  to  know  that 
though  it  is  a grave  occurrence,  the  majority  of 
children  who  have  them,  unless  suffering  from  some 
other  disease,  recover.  Convulsions  are  evidence 
that  there  is  something  wrong  about  the  great  cen- 
tres of  the  nervous  system,  the  brain  and  spinal  cord. 
But  it  does  not  follow,  of  necessity,  that  there  is 
absolute  organic  disease  existing  in  them.  Thus,  a 
child  whose  teeth  are  coming  forward,  and  pressing 
against  the  gum,  may  suddenly  be  seized  with  a con- 
vulsion, and  yet  there  cannot  be  said  to  be  disease 
of  the  brain  in  this  case.  The  irritation  of  the 
nervous  system  produced  by  teething,  has  fitted  the 
child  for  the  occurrence  of  the  convulsion,  which 
takes  place  at  the  moment  when  no  more  can  be 
endured.  So  it  is  with  irritation  of  the  nervous 
system  produced  by  undigested  substances  in  the 
bowels,  and  these  two  are  the  principal  causes  of 
convulsions  in  healthy  children. 

Persons  will  be  heard  to  speak  of  spasms,  of  fits, 
and  of  convulsions,  an  apparent  distinction  being 
made  between  them.  Other  terms  in  popular  use 
are  “inward  fits,”  or  “inward  convulsions,”  and 
these  are  sometimes  used  to  convey  a supposed 
distinct  idea.  To  aid  in  removing  the  confusion 


200 


OF  EMERGENCIES. 


Convulsions  may  le  general  or  partial.  Description. 

sometimes  produced  by  the  use  of  these  various 
terms,  I will  define  them,  giving  to  each  what  1 
believe  to  be  its  appropriate  force  and  signification. 

A convulsion,  then,  is  a condition  in  which  the 
muscles  contract  without  the  control  of  the  will,  and 
frequently  without  the  consciousness  of  the  individ- 
ual. Sometimes  it  is  partial,  being  confined  to  a 
single  muscle  which  twitches  and  contracts,  or  it 
may  affect  all  the  muscles  of  one  side,  or  it  may  act 
more  or  less  upon  all  of  the  muscles  of  the  body. 
When  it  affects  the  whole  it  is  a general  convulsion, 
and  the  body  and  limbs  may  be  straightened  out,  in 
fact  bending  back  somewhat,  or  the  body  may  be 
bent  forward  at  the  same  time  that  the  limbs  are 
doubled  up,  the  hands  being  brought  upon  the  chest, 
or  to  the  face,  and  the  knees  being  curled  up  almost 
against  the  body.  The  face  is  usually  distorted  at 
the  same  time — the  eyes  turning  upward  and 
inward,  the  mouth  being  drawn  to  one  side,  or  the 
various  muscles  of  the  face  contracting  with  irregu- 
larity, and  producing  constant  but  irregular  motions. 
The  breathing  becomes,  at  the  same  time,  interrupted 
by  sighing.  This  may  occur  suddenly,  last  ten  or 
fifteen  minutes,  and  then,  the  motions  ceasing,  the 
child  breathes  more  regularly  and  drops  off  into  a 
sleep,  not  usually  lasting  more  than  half  an  hour. 


OF  EMERGENCIES. 


201 


Fit.  Spasm.  Inward  Fits. 

The  word  fit  is  used  to  describe  precisely  the  same 
thing  when  general,  and  the  words  are  therefore 
identical  in  meaning,  though  convulsion  is  the  least 
ambiguous.  I shall  therefore  employ  it  in  prefer- 
ence. 

The  word  spasm  is  sometimes  used  to  describe  the 
same  general  condition,  but  it  is  more  frequently 
reserved  to  represent  that  partial  contraction  of  a 
single  muscle,  or  a single  group  of  muscles,  to  which 
I have  before  referred.  It  is  very  convenient  to 
make  this  distinction,  though  it  is  not  unusual  to 
hear  general  spasms  spoken  of,  and  certainly  there 
is  no  impropriety  in  the  use  of  such  a phrase. 

The  expressions  “inward  fits,”  and  “inward  con- 
vulsions,” seem  to  be  applied,  so  far  as  I have 
observed,  to  that  condition  in  which  there  is  slight 
motion  about  the  face  produced  by  irregular  con- 
tractions of  muscles,  but  in  which  there  is  no  general 
convulsion.  I have  also  heard  them  used  when  the 
eyes  have  turned  up  under  the  lids,  the  child  half 
sleeping  and  restless.  They  are  intended  to  imply 
that  there  is  some  dangerous  internal  condition,  but 
are  used  so  vaguely,  and  are  so  unnecessary,  that 
they  should  be  entirely  discarded. 

Without  spending  more  time  upon  these  distinc- 


202 


OF  EMERGENCIES. 


Premonitory  symptoms. 

tions,  I may  add  that  in  children  both  partial  and 
general  convulsions  arise  from  the  same  causes,  and 
require,  in  the  main,  the  same  treatment.  The  par- 
tial are  evidence  of  less  protracted  or  extensive 
influences,  and,  as  might  be  supposed,  frequently  pre- 
cede the  more  general.  I shall  therefore  speak  of 
them  together. 

When  convulsions  occur  in  a child  that  is  in 
apparent  health,  some  cause  of  irritation  can  usually 
be  found.  There  may  or  not  have  been  premonitory 
symptoms.  They  almost  always  occur,  but  are  fre- 
quently overlooked.  They  consist  in  complaints  of 
slight  dizziness,  or  headache,  with  a flushing  of  the 
cheek,  or  it  may  be  of  unusual  pallor.  The  child 
does  not  seem  quite  right,  and  yet  is  not,  in  appear- 
ance, greatly  out  of  tune.  Sometimes  he  appears 
for  a few  days  to  be  languid,  and  there  may  be 
derangement  of  the  bowels,  either  by  their  being 
constipated  or  the  reverse.  But  after  thus  ailing  for 
a few  days,  he  is  suddenly  seized  with  a convulsion 
while  lying  on  his  bed,  or  it  may  even  be  while 
playing  as  usual.  The  first  question  is  as  to  what  is 
to  be  done  in  this  condition. 

There  is  a saying,  most  common  among  the 
French,  I believe,  to  the  effect  that  if  a little  salt 


OF  EMERGENCIES. 


203 


The  treatment.  The  first  thing  to  he  done. 

be  put  upon  the  tip  of  the  tongue,  it  will  stop  the 
convulsion.  Now  I will  not  advise  any  one  to  try 
this,  but  thus  illustrate  the  fact  that  convulsions, 
when  occurring  in  a healthy  child,  frequently  termi- 
nate favorably  without  any  treatment  by  medicine. 
Still  it  is  not  desirable  to  let  them  run  on,  without 
any  efforts  to  put  a stop  to  them.  Some  little  time 
will  be  required  to  prepare  the  materials  for  the 
treatment  subsequently  rocommended,  and  this  time 
is  quite  sufficient  to  try  the  experiment  of  waiting 
to  see  if  nature  will,  without  aid,  accomplish  a cure. 
During  this  time  the  child’s  clothes  should  be 
unloosed,  especial  search  being  made  for  pins  that 
may  be  pricking  it,  and  sometimes  are  the  only 
occasion  of  the  disturbance.  Care  should  be  taken 
that  the  patient  does  not  hurt  himself  by  knocking 
his  head  against  hard  substances,  or  in  any  other 
way.  If  the  hands  are  curled  up,  the  fingers  being 
closed  upon  the  palm,  there  is  a great  inclination  on 
the  part  of  the  bystanders  to  constantly  draw  them 
open,  in  the  common  belief  that  they  will  thus  do 
something  for  the  good  of  the  patient.  This  does 
not,  in  fact,  do  any  good,  but  if  it  will  keep  any  one 
from  doing  something  which  is  absolutely  injurious, 
the  desire  may  be  gratified,  although  it  is  decidedly 


204 


OF  EMERGENCIES. 


When  and  how  to  give  a warm  bath.  Its  design. 

better  to  leave  the  child  entirely  to  himself,  so  far 
as  these  things  are  concerned.'  After  five  or  even 
ten  minutes  have  been  allowed  to  pass,  if  the  child 
does  not  become  quiet,  either  dropping  asleep,  or 
waking  up  in  surprise  that  so  many  should  be  stand- 
ing round  him,  a warm  bath  may  be  prepared,  his 
clothes  stripped  from  him,  and  he  put  into  it.  Its 
temperature  should  be  as  high  as  he  can  comfortably 
bear,  care  being  taken  not  to  scald  him ; the  safer 
way  being  to  make  it  so  that  it  is  about  as  warm  as 
the  mother’s  hand,  plunged  in  half  way  to  the  elbow, 
can  comfortably  bear.  Should  it  be  desirable,  warm 
water  may  be  afterwards  added  to  it,  while  the  child 
is  in  the  bath.  In  this  water  his  body  should  be 
placed,  with  his  head  and  shoulders  out,  and  upon 
his  head  there  should  be  placed  a.  constant  succession 
of  cloths  wrung  out  of  cold  water.  The  design  of 
these  baths,  and  of  the  cold  application  at  the  same 
moment,  is,  to  draw  the  blood  to  the  surface  from 
any  internal  organs,  whether  the  brain  or  other  to 
which  it  has  crowded,  and  thus  to  relieve  the  condi- 
tion on  which  the  convulsion  depends.  Five  minutes 
is  as  long  as  the  child  should  remain  thus  immersed, 
it  being  better  to  repeat  it  if  necessary,  than  to  con- 
tinue it  without  any  interruption.  A soft  and  thick 


OF  EMERGENCIES. 


205 


When  injections  are  useful. 

blanket  should  be  ready,  to  wrap  around  the  child's 
body  as  soon  as  he  conies  out  of  the  tub,  and  he 
should  thus  remain,  no  effort  being  made  to  dress 
him  while  the  convulsion  lasts,  or  during  the  time 
that  he  lies  asleep  after  it  has  passed  off.  Still, 
there  is  no  occasion  to  expose  him  to  taking  cold. 

When  there  has  been  constipation  previous  to  the 
attack,  or  when  the  attack  does  not  yield  to  the  use 
of  the  warm  bath,  an  injection  should  be  given. 
For  this  purpose,  it  being  desirable  that  it  should 
act  promptly,  it  should  be  of  a stimulating  charac- 
ter ; and  I therefore  recommend  a soap  suds  injection, 
made  strong  for  the  age  of  the  child,  and  add  to  it 
a full  dose  of  castor  oil,  or  sweet  oil  if  the  other  is 
not  at  hand.  Small  worms,  commonly  called  thread 
worms,  will  sometimes  excite  convulsions,  and  there- 
fore, when  a child  is  thus  seized  after  these  have  been 
seen  in  the  discharges,  the  injection  may  precede  the 
bath.  In  this  case,  a half  of  a teaspoonful  of  tinc- 
ture of  aloes  added  to  the  injection  will  make  it 
more  effective,  this  destroying  the  worms  more  cer- 
tainly. So  important  is  the  injection,  used  in  this 
way,  that  immediate  relief  sometimes  follows  the 
discharge  which  it  produces. 

As  soon  as  possible,  the  probable  occasion  of  the 


206 


OP  EMERGENCIES. 


The  cause  to  he  ascertained.  When  to  give  emetics. 

convulsion  should  be  sought  for,  that  it  may  be 
'removed,  for  if  it  continues  it  is  not  unlikely  to 
produce  the  same  effects  again,  and  thus  a recur- 
rence of  the  convulsions  would  be  secured.  For 
this  purpose  the  gums  should  first  be  examined,  if 
the  patient  is  of  an  age  to  make  it  probable  that  the 
teeth  are  the  cause  of  the  disturbance.  If  there  is 
any  swelling  of  the  gums,  they  should  be  cut  in  the 
manner  I have  previously  recommended.  Of  course 
it  is  better  for  a physician  to  do  it,  but  if  he  is  too 
distant  to  arrive  soon,  or  if  he  is  detained,  the 
mother  is  justified  in  doing  it  herself.  Should  there 
be  no  cause  to  believe,  after  examination,  that  press- 
ing teeth  are  the  cause  of  the  disturbance,  or  should 
there  be  positive  reason  for  the  opinion  that  it  is 
caused  by  food  that  has  been  taken  by  the  child,  a 
mild  emetic  should  be  given.  By  positive  reason, 
I mean,  that  it  is  known  that  there  has  been  some 
unusual  quantity  eaten,  or  that  the  child  has  had 
that  which  is  not  like  its  ordinary  diet.  Thus,  a 
nursing  child  may  be  thrown  into  this  condition  in 
consequence  of  the  imprudence  of  the  mother  in 
some  article  of  diet,  which,  by  its  injurious  effect 
upon  her,  has  changed  the  quality  of  her  milk ; or 
strong  mental  emotions,  such  as  anger  or  fear,  may 


OF  EMERGENCIES. 


207 


How  to  excite  vomiting. 

produce  the  same  effect,  and  in  the  same  way.  The 
child  that  is  weaned  may  have  had  something  undi- 
gestible  given  to  it — raisins,  for  instance,  which  are 
among  the  worst  things  that  a child  can  eat ; or 
may  have  eaten  its  food  too  hastily,  swallowing  it  in 
pieces  instead  of  reducing  it  to  a homogeneous  mass 
by  chewing  it  very  fine.  Apples  are  especially  apt 
to  be,  in  this  way,  the  cause  of  trouble.  To  excite 
vomiting,  take  a feather  first,  about  as  large  as  a 
small  goose  quill,  such  as  are  used  for  pens,  and, 
opening  the  mouth,  tickle  the  back  part  of  the 
throat  as  far  down  as  can  be  reached  with  the  tip  of 
the  feather.  If  this  does  not  succeed  warm  water 
may  be  given,  and  if  this  does  not  cause  vomiting 
almost  immediately,  it  may  be  followed  by  another 
half  tumbler  full,  to  which  a quarter  or  third  of  a 
teaspoonful  of  ground  mustard  has  been  added. 
Common  salt,  in  the  same  quantity,  will  answer  the 
same  purpose,  I think  not  quite  so  readily  or  so 
easily  as  mustard.  The  disturbance  of  the  whole 
system  which  the  act  of  vomiting  produces,  seems  to 
act  quite  favorably,  so  that  the  only  objection  to  its 
being  resorted  to  is  from  fear  of  its  excess.  It  is  for 
this  reason  that  I have  not  recommended  more  vio- 
lent emetics,  such  as  ipecacuanha,  squills,  and  anti- 


208 


OP  EMERGENCIES. 


When  no  fluids  are  to  be  given.  Cathartics. 

mony.  It  is,  however,  to  be  borne  in  mind  that 
during  the  time  of  the  actual  convulsion,  the  child 
cannot  swallow,  and  there  is,  therefore,  no  use  in 
pouring  these  or  any  other  remedies  into  its  mouth. 
In  fact,  to  do  so  is  to  run  the  risk  of  having  some 
part  of  the  liquids  drawn  into  the  windpipe,  instead 
of  the  stomach,  and  a violent  fit  of  coughing,  or  even 
suffocation,  may  be  thus  produced.  I repeat,  that 
the  warm  bath  and  other  external  applications  are 
recommended  to  put  a stop  to  the  convulsion,  while 
the  emetics  and  other  remedies  are  intended  to  pre- 
vent its  recurrence,  by  removing  the  cause. 

After  the  occurrence  of  a convulsion  arising  from 
the  causes  of  which  I have  spoken,  it  is  well  to  give 
a mild  cathartic,  even  if  the  stomach  has  been 
emptied  by  vomiting.  Some  of  the  undigested 
materials,  if  this  was  the  cause,  may  have  passed 
into  the  intestine  and  should  be  removed,  for  the 
same  reason  that  such  a course  was  necessary  in 
regard  to  the  stomach.  If  dental  irritation  is  the 
cause,  the  cathartic  seems  also  to  produce  a very 
desirable  impression,  and  one  that  is  beneficial. 
This  is  one  of  the  conditions  in  which  I prefer  to 
use  castor  oil  in  the  full  dose  appropriate  to  the  age 
of  the  child. 


OF  EMERGENCIES. 


209 


Convulsions  preceding  eruptions.  Distinctive  marks  of  eruptive  fevers. 

Convulsions  in  apparently  healthy  children,  are 
sometimes  excited  by  other  causes  than  those  which 
I have  enumerated.  They  are  frequently  the  fore- 
runners of  diseases,  of  which  no  other  symptom  has 
before  appeared.  It  is  the  eruptive  diseases  which 
are  especially  apt  to  be  thus  announced.  These  are 
scarlet  fever,  measles,  small  pox,  rose  rash,  and 
chicken  pox.  The  usual  history  in  such  cases  is  like 
this.  The  child,  after  its  seizure,  is  put  into  a warm 
bath,  which  quiets  it,  and  it  drops  asleep  while 
wrapped  in  the  warm  blankets.  On  opening  the 
blanket  to  dress  it,  a rash  or  distinct  eruption  is 
seen  upon  the  surface,  and  is  the  first  indication  of 
the  disease  by  which  the  child  has  been  attacked. 
Of  course  the  physician  should  be  at  once  sent  for, 
to  take  the  charge  of  the  case.  At  other  times,  the 
eruption  does  not  immediately  appear,  but  after 
recovering  from  the  convulsion  the  patient  remains 
hot  and  feverish,  the  peculiar  marks  of  the  disease 
developing  themselves  only  after  twenty-four  hours. 

As  I have  not  thought  it  wise  to  dwell  upon  these 
diseases  minutely,  I will  here  add  the  most  distinc- 
tive marks  of  these  various  eruptions.  Scarlet  fever, 
scarlatina,  or  scarlet  rash  (for  these  names  all  mean 
the  same  thing),  is  distinguished  by  a more  or  less 
14 


210 


OF  EMERGENCIES. 


Scarlet  .fever.  Rose  rash.  Measles. 

extended,  uniform,  red  eruption,  not  much  raised 
above  the  surface,  accompanied  by  a high  fever,  and 
frequently  appearing  first  about  the  joints,  as  at  the 
bend  of  the  elbow,  or  under  the  knee.  In  many 
cases  a sore  throat  precedes  it,  but  this  is  not  always 
so,  and  especially  when,  as  I have  above  supposed, 
it  is  ushered  in  by  a convulsion.  The  only  disease 
with  which  it  is  very  likely  to  be  confounded  is  rose 
rash,  which  may  be  suspected  if  the  disturbance  is 
slight,  if  the  patches  are  small,  and  scarlet  fever  is 
not  known  to  be  prevalent,  or  has  once  before 
attacked  the  patient.  Eose  rash  (or  roseola)  is  a 
mild  disease,  and  the  eruption  is  of  a rose  color, 
while  that  of  scarlet  fever  is  accurately  described  by 
comparing  it  to  the  color  of  the  shell  of  a well 
boiled  lobster.  Whichever  appears,  the  physician 
should  be  consulted.  Scarlet  fever  does  not  usually 
occur  but  once  in  the  same  patient ; rose  rash  is  not 
thus  limited. 

The  eruption  of  measles  is  of  a paler  color  than 
either  of  the  others,  and  appears  first  about  the  face, 
on  the  forehead,  chin,  nose,  and  cheeks.  It  is  not 
uniform,  but  in  little  patches,  and  when  the  finger  is 
passed  over  them  there  can  be  felt  to  be  a decided 
roughness  of  the  surface. 


OF  EMERGENCIES. 


211 


Small  pox.  Chicken  pox.  Convulsions  after  severe  sickness. 

The  eruption  is  usually  preceded  for  a day  or  two 
by  indications  of  a cold  in  the  head,  the  eyes  being 
watery,  the  nose  constantly  discharging  an  excess  of 
secretion,  while  there  is  an  annoying  sneezing,  with 
a ringing  cough. 

Small  pox  ought  not  to  occur,  because  the  child 
should  be  carefully  vaccinated,  whether  in  the  city  or 
country,  within  six  months  of  the  time  of  its  birth. 
When  it  does,  the  eruption  is  first  seen  about  the 
nose,  but  in  small  pointed  pimples,  which  rapidly 
increase  in  size,  sometimes  running  together. 

Chicken  pox  is  not  unlike  small  pox  in  its  erup- 
tion, but  it  appears  in  most  cases  principally  upon 
the  back,  is  accompanied  by  some  itching,  and  is 
rarely  ushered  in  by  convulsions.  Its  pimples 
change  into  pustules,  somewhat  like  small  pox,  and 
when  these  are  upon  the  face,  may  leave  decided 
scars.  This  is  an  annoying,  but  rarely  a fatal  dis- 
ease. The  physician  does  not  usually  need  to  see 
the  patient  more  than  once. 

But  to  return  from  this  long  digression,  I add,  with 
regard  to  general  convulsions,  that  when  they  occur 
after  a long  or  violent  sickness,  it  is  a grave  indica- 
tion. Protracted  diarrhoeas,  lung  fever,  water  on 
the  brain,  and  other  diseases  sometimes  terminate 


212 


OF  EMERGENCIES. 


Local  spasms.  Saint  Vitus’  dance. 

fatally  in  this  way,  and  the  physician  should  be  at 
once  notified  of  the  occurrence.  The  remedies 
which  I have  previously  spoken  of,  are,  under  these 
circumstances,  of  little  use,  though  the  warm  bath 
may  be  cautiously  tried,  if  the  physician  in  attend- 
ance cannot  be  immediately  consulted. 

Partial  convulsions^  or  local  spasms,  usually  arise 
from  the  same  causes  that  produce  general  con- 
vulsions. They  are  of  importance,  even  if  they 
consist  in  a simple  involuntary  twitching  of  the 
mouth,  because  the  condition,  if  neglected,  may  lead 
to  a more  general  attack,  which  is  every  way  unde- 
sirable. An  examination  of  the  gums,  attention  to 
the  diet,  regulation  of  the  bowels,  whether  consti- 
pated or  the  reverse,  and  forbidding  all  amusements 
which  seem  especially  to  excite  the  child,  are  among 
the  necessary  modes  of  treatment.  The  warm  bath 
should  be  more  carefully  given  every  day,  and  every 
effort  should  be  made  to  restore  the  child  to  a con- 
dition of  perfect  health. 

There  is  one  disease  which  is  characterized  by  the 
spasmodic  and  involuntary  contraction  of  the  mus- 
cles of  the  whole  frame,  and  receives  its  name  from 
the  strange  distortions  of  the  features,  and  pecu- 
liar positions  of  the  patient.  This  is  Saint  YiW 


OF  EMERGENCIES. 


213 


Choiring.  Occasion  of  it. 

dance.  Its  causes  are  so  various  that  I shall  not 
recommend  any  plan  of  treatment,  for  it  could  not 
be  possible  to  suit  even  a majority  of  cases.  When 
the  disease  occurs,  the  patient  should  be  immedi- 
ately placed  in  charge  of  a physician,  for  few  cases 
become  permanent  when  treated  early.  It  may  be 
a comfort  to  some  mother  to  know  that  the  disease 
is  rarely,  if  ever,  fatal. 

Of  Choking . 

Another  occurrence  which  allows  no  time  for  con- 
sultation, but  demands  immediate  and  intelligent 
action  is  choking  ; that  is,  the  more  or  less  com- 
plete obstruction  of  the  windpipe.  The  inability  to 
breathe  freely  at  once  produces  great  distress,  and, 
if  the  interference  is  great,  life  may  be  soon  lost. 
Hence  the  importance  of  the  mother’s  knowing  what 
to  do,  for  children  are  especially  liable  to  this  acci- 
dent. There  are  two  ways  of  choking,  as  the 
phrase  is  popularly  used,  which  require  different 
treatment.  The  one  to  which  the  term  is  most  prop- 
erly applied  is  when  a piece  of  solid  substance  gets 
into  the  upper  part  of  the  windpipe  in  such  a way 
as  to  prevent  air  passing  by  it  to  the  lungs.  This 
may  be  caused  by  any  substance,  as  a mouthful  of 


214 


OF  EMERGENCIES. 


Its  symptoms  and  treatment. 

meat,-  which  the  individual  attempts  to  swallow. 
Sudden  and  violent  laughter  with  the  mouth  filled 
with  food  may  cause  this.  Its  symptoms  are  imme- 
diate distress  for  breath  ; efforts  to  inhale,  which  are 
evidently  unsuccessful ; little  or  no  cough  ; a distress- 
ed and  anxious  look,  together  with  a flushed,  purple 
hue  of  the  face,  rapidly  deepening  in  color,  and  if  the 
obstruction  is  not  at  once  removed  death  soon  fol- 
lows. The  mother  must,  under  these  circumstances, 
act  at  once,  for  there  is  no  time  to  wait  for  a doctor 
to  arrive.  A smart  blow  with  the  flat  of  the  hand 
on  the  back,  just  below  the  neck,  will  sometimes 
serve  to  dislodge  the  substance,  but  if  one  or  two  of 
these  do  not  bring  immediate  relief  they  should  not 
be  repeated.  The  mother’s  finger  may  then  be 
passed  directly  into  the  mouth  between  the  back 
teeth,  or  even  between  the  jaws  behind  them,  still 
on  to  the  back  of  the  throat.  Turning  the  tip 
of  the  finger  slightly  downward,  it  should  then  be 
bent  and  moved  about,  but  not  with  violence,  to 
seek  for  and  remove  the  offending  substance, 
whatever  it  may  be.  This  will  be  found  behind 
the  roots  of  the  tongue,  and  directly  in  the  middle 
of  the  throat,  and  the  hooked  finger  will  often,  when 
brought  forward,  dislodge  it.  When  done  with  cool- 


OP  EMERGENCIES. 


215 


Another  way  of  cholcing. 

ness  and  dexterity,  this  method  is  usually  successful, 
if  the  obstructing  morsel  is  of  considerable  size. 

If  these  methods  fail,  the  child  may  be  taken  up, 
turned  head  downward,  and  a smart  blow  upon  the 
back  will  then  dislodge  the  obstruction.  This  seems 
like  a harsh  and  unscientific  method,  but  I speak  of 
it  with  some  confidence,  and  some  affection  perhaps, 
for  to  the  coolness  of  my  father,  in  executing  it,  I 
owe  the  preservation  of  my  life,  when,  from  such  an 
accident  in  childhood,  I had  become  senseless. 

A much  more  common  occurrence  is  for  some  very 
small  particle,  as  a crumb  of  bread,  or  of  potato,  or 
a drop  of  water,  or  other  liquid,  to  get  into  the 
upper  part  of  the  windpipe.  In  common  phraseol- 
ogy this  is  said  to  have  gone  the  wrong  way,  and 
nothing  can  be  more  true,  for  it  was  intended  to  be 
swallowed,  and  instead  of  this  it  has  gone  into  the 
passage  intended  for  air  only.  There  is  a very 
exquisite  arrangement  made  for  guarding  this  pass- 
age against  any  intruding  substances,  by  the  endow- 
ment of  the  upper  part  of  the  passages  with  an  acute 
sensibility,  so  that  at  the  first  approach  of  a strange 
body,  the  alarm  may  be  given,  and  the  opening  may 
be  closed.  Now  a small  particle  of  any  substance 
touching  this  part,  at  once  excites  violent  coughing, 


216 


OP  EMERGENCIES. 


No  danger.  The  treatment. 

the  design  of  this  very  effort  being  to  expel  the 
intruder.  When  this  is  accomplished,  the  irritation 
soon  passes  away,  the  cough  of  course  ceasing.  If, 
however,  the  irritating  particle  is  not  readily 
expelled,  the  coughing  continues  to  be  quite  violent, 
and  produces  great  alarm  in  the  sufferer,  as  well  as 
the  spectators.  It  is  comforting  to  know  that  this 
kind  of  choking  is  not  dangerous,  like  the  other  of 
which  I have  before  spoken.  A blow  upon  the  back, 
as  I previously  recommended,  will  sometimes  dis- 
lodge the  offending  particle,  and  can  be  tried  at 
once  ; search  for  it  may  then  be  made  by  the  finger, 
and  if  this  does  not  succeed,  the  cough  continuing 
to  be  very  violent  for  a few  minutes,  the  air  pas- 
sages may  then  become  more  tolerant  of  the  foreign 
body,  and  the  violence  and  frequent  repetition  of  the 
cough  lessen.  When  the  lull  comes,  a draught  of 
cold  water  may  be  taken.  This,  by  the  effort  of 
swallowing,  tends  to  remove  the  substance,  or  if 
this  has  already  gone,  though  some  irritation 
remains,  as  is  sometimes  the  case,  its  coolness  tends 
to  allay  it.  This  violent  coughing,  though  alarming, 
does  not  terminate  in  complete  closure  of  the  wind- 
pipe, as  is  the  case  when  a piece  of  meat  is  drawn 
into  it  and  stops  it  up.  The  obstruction  is  from  a 


OF  EMERGENCIES. 


217 


Seeds , coins , <&c.}  in  Wie  windpipe.  Fish  hones  in  the  throat. 

spasm  of  the  muscles,  and  therefore  it  is  that  I say 
it  is  not,  like  that,  dangerous. 

Sometimes  substances  of  considerable  size,  such 
as  seeds,  coins,  beans,  &c.,  pass  through  the  narrow 
chink  at  the  upper  part  of  the  windpipe,  and  almost 
to  the  lungs  themselves.  The  assistance  of  a sur- 
geon is  necessary,  at  as  early  a moment  as  possible. 
If  it  be  a coin  that  is  the  offending  substance,  trial 
can  be  made  before  his  arrival  of  reversing  the 
position  of  the  patient,  that  is,  holding  him  a moment 
with  his  head  down.  But  if  the  distress  of  the 
patient  is  not  great,  as  may  be  the  case,  it  is  better 
to  wait  for  the  arrival  of  the  surgeon,  because 
attempts  to  dislodge  the  substance  may  result  in 
bringing  it  into  a more  unfavorable  position. 

When  a child,  in  eating  solid  food,  does  not  chew 
it  sufficiently,  or  when  he  attempts  to  swallow  too 
much  at  once,  it  sometimes  sticks  in  the  gullet,  pro- 
ducing quite  unpleasant  sensations,  though  not  inter- 
fering with  the  breathing.  A full  draught  of  cold 
water  will  aid  in  carrying  the  mass  along. 

Fish-bones  sticking  by  the  way,  may  often  be 
removed  by  crusts  of  bread,  eaten  for  that  purpose, 
but  the  advice  of  a surgeon  is  not  unfrequently 
necessary. 


218 


OF  EMERGENCIES. 


Swallowing  pins , buttons , <&c.  Foreign  bodies  in  the  note  and  ears. 

When  other  bodies,  such  as  pins,  or  buttons,  or 
coins,  are  partly  swallowed,  if  they  are  not  in  sight 
it  is  usually  necessary  to  allow  them  to  pass  through 
the  bowels,  though  occasionally  pins  and  other 
pointed  substances  require  to  be  removed  by  a sur- 
geon. After  they  are  swallowed,  it  is  well  to  keep 
the  child  on  solid  vegetable  diet,  which  is  more 
bulky  than  meat,  and  better  calculated  to  carry  the 
material  safely  along  than  fluids.  It  is  not  wise  to 
give  violent  cathartics,  the  utmost  being  every  other 
day  a small  dose  of  castor  oil.  The  evacuations 
should  be  watched,  that  the  offending  substance  may 
be  found  in  them,  and  the  parent’s  anxiety  be,  by  its 
appearance,  entirely  removed. 

Substances  in  the  Nose  and  Ears . 

Why  it  is  I cannot  say,  but  children  have  a strong 
inclination  to  put  various  things  into  their  nostrils, 
and  into  their  ears.  Peas,  beans,  bits  of  glass,  alum, 
pebbles,  almost  all  kinds  of  strange  things  they  will 
squeeze  into  these  passages,  often  with  great  labor 
and  industry.  There  is  no  immediate  danger  in 
either  of  these,  and  the  mother  should  not  make  very 
protracted  efforts  to  get  them  out,  before  she  sends 
for  the  surgeon,  because  she  may  do  more  harm  than 


OP  EMERGENCIES. 


219 


Earwigs  not  dangerous.  What  to  do  when  a child’s  clothes  take  fire. 

would  otherwise  have  resulted  from  the  occurrence. 
It  is  for  the  purpose  of  giving  this  caution,  chiefly, 
that  I refer  to  the  matter.  But  I may  add,  that 
there  is  no  occasion  for  the  anxiety  often  felt  lest 
substances  put  into  the  passage  of  the  ear  should  get 
to  the  brain.  There  is  a strong  membrane,  stretched 
firmly  across  the  passage,  sufficient  to  prevent  sub- 
stances making  their  way  any  further  in,  but  were  it 
absent  there  would  be  no  ’danger  of  their  penetrat- 
ing to  the  brain  itself.  The  anatomical  arrange- 
ment of  the  part  is  such,  that  this  is  entirely 
impossible.  The  legends  of  earwigs,  and  other 
monsters,  creeping  into  children’s  ears  while  they 
sleep,  and  destroying  them  by  going  to  the  brain, 
are  not  even  founded  in  fact.  Moral  earwigs  are 
the  only  ones  that  are  to  be  feared,  and  carefully 
guarded  against. 

Burns  and  Scalds. 

These  are  perpetually  occurring,  and  when  exten- 
sive, or  in  certain  situations,  are  indeed  fearful.  Imme- 
diate and  intelligent  action  is  necessary  to  save  the 
life  of  the  patient.  When  a child’s  clothes  take  fire, 
throw  him  down  upon  the  floor  at  once,  and  roll  him 
over  and  over,  for  in  this  way,  if  you  do  not  extin- 


220 


OP  EMERGENCIES. 


Of  taking  off  the  clothes.  Local  applications.  Oil,  flour,  and  cotton. 

guish  the  fire,  you  will  put  a stop  to  his  increasing  it 
by  running  about,  and  will  lessen  the  chances  of  his 
chest  being  burned,  or  of  his  inhaling  the  flames, 
both  of  which  seriously  endanger  life.  If  there  is 
anything  at  hand  made  of  wool,  as  a rug,  a piece  of 
carpet,  a cloak,  or  shawl,  wrap  him  in  it  at  the  same 
moment.  The  chances  of  extinguishing  the  flames 
are  thus  greatly  increased,  and  this  is,  of  course,  the 
first  thing  to  be  done.  When  the  fire  is  extinguished, 
the  clothes  should  at  once  be  carefully  taken  off, 
especial  pains  being  taken  not  to  pull  off  the  surface 
of  the  skin  at  the  same  time,  for  this  aggravates  the 
pain,  and  seriously  increases  the  danger.  This  is 
difficult  when  blisters  have  arisen,  but  should  be 
accomplished  so  far  as  possible.  A cotton  or  linen 
night  gown  can  then  be  put  on,  and  the  child  put  in 
bed,  if  the  burn  is  extensive,  or  if  it  is  upon  the 
chest  — a comparatively  small  burn  here  being 
attended  with  increased  danger.  Over  the  part  that 
is  burned,  oil  that  is  not  rancid  must  be  poured,  so 
that  the  whole  surface  is  greased.  Olive  oil  is  gen- 
erally obtained  the  most  readily,  but  linseed  oil  is 
better.  In  want  of  these,  lard  may  be  used.  Fine 
wheat  flour  should  then  be  dusted  over  the  surface 
thus  oiled,  and  this  can  be  best  done  with  a dredg- 


OP  EMERGENCIES. 


221 


Carron  oil  and  paint. 

ing-box.  The  layer  of  flour  should  be  quite  thick, 
and  should  extend  a little  beyond  the  burnt  surface. 
Over  this  again  should  be  placed  a layer  of  fine  cot- 
ton batting,  or  light  and  flocculent  carded  cotton, 
which  should  be  kept  in  its  place,  if  necessary,  by 
very  light  bandaging.  Each  of  these  three  sub- 
stances, the  oil,  the  flour,  and  the  cotton,  are  often 
used  separately,  but  I like  their  combination  better. 
If  either  is  not  readily  at  hand,  the  other  two  may 
be  used,  and  if  only  one  can  be  at  once  resorted  to, 
it  should  be  used.  The  oil,  alone,  is,  however,  less 
beneficial  than  either  of  the  others.  It  is  difficult 
to  imagine  how  one  could  be  so  situated  that  flour 
would  not  be  immediately  at  hand.  When  possible, 
it  is  well  to  use,  instead  of  the  oil,  a mixture  of 
equal  parts  of  lime  water  and  linseed  oil,  known  in 
some  districts  by  the  name  of  Carron  oil,  from  its 
successful  use  in  cases  of  such  accidents  at  the 
Carron  works  in  England.  Its  odor,  however,  is 
rather  disagreeable.  Common  white  lead,  ground 
in  oil,  has  also  been  recommended  by  good  authority, 
but  I doubt  if  it  is  any  better  than  the  simple  lin- 
seed oil.  It  may  sometimes  be  more  conveniently  at 
hand  than  the  other  substances,  and  is  therefore  to 
be  borne  in  mind.  It  should  be  spread  over  the 


222 


OF  EMERGENCIES. 


When  stimulants  are  necessary.  Winter  dresses  should  be  made  cf  wool. 

whole  surface.  The  flour  and  cotton  appear  to  be 
of  benefit,  chiefly  from  their  preventing  the  contact 
of  the  air,  which  is  an  important  consideration. 
After  their  application,  they  should  not  be  disturbed, 
and  if  they  become  misplaced,  or  fall  off,  they 
should  be  at  once  renewed. 

After  these  external  applications  have  been  made 
if  there  is  any  coldness  of  the  extremities,  light 
but  warm  coverings  should  be  put  upon  the  bed,  and 
hot  cloths  should  be  put  around  the  feet,  and  a bot- 
tle of  hot  water  added  to  keep  up  the  temperature. 
When  extreme  prostration  comes  on,  wine  whey,  or 
milk  punch  may  be  given  as  freely  as  seems  to  be 
required  by  the  circumstances.  When  all  this  has 
been  done,  the  arrival  of  the  physician  can  be 
awaited  with  equanimity,  but  he  should  be  sent  for 
immediately  on  the  occurrence  of  the  accident.  I 
repeat,  that  a burn  upon  the  chest  is  a more  grave 
accident  than  one  of  the  same  size  elsewhere,  but 
with  this  exception,  the  extent  and  depth  of  the 
burn  are  the  measure  of  its  danger.  It  is  proper  to 
add,  that  it  is  a necessary  precaution  when  open 
fires,  or  hot  stoves  are  used,  to  clothe  children  in 
woolen  instead  of  cotton,  which  is  much  more  inflam- 
mable. 'The  neglect  of  this  precaution  is  every 
year  the  occasion  of  loss  of  life. 


OF  EMERGENCIES 


223 


How  scalds  differ  from  burns. 

Scalds  differ  from  burns  only  by  the  different 
mode  in  which  the  heat  is  applied.  They  are,  how- 
ever, frequently  more  extensive,  the  hot  liquid  pene- 
trating and  running  through  the  clothing  to  a much 
larger  surface  than  is  reached  by  the  flames,  or  the 
red-hot  solid.  The  injury  is,  moreover,  instantly 
done.  If  a child  falls  into  a hot  liquid,  he  should  at 
once  be  snatched  out  of  it,  but  a fatal  scald  is  the 
common  result  of  such  an  accident.  A scalding 
liquid,  if  poured  on,  is  usually  in  a jet,  or  shower 
of  short  duration,  which  has  done  the  mischief 
before  any  one  can  interfere.  From  their  extent 
and  from  their  situation,  being  often  upon  the  chest, 
scalds  are  frequently  fatal.  Their  treatment  is  the 
same  as  that  of  burns.* 

* The  following  facts,  which  I gather  from  the  last  census  of  the  United  States, 
are  of  interest,  and  may  serve  to  illustrate  and  enforce  the  importance  of  my  sug- 
gestions on  this  subject.  There  are  reported  for  the  year  ending  June  1st,  1850, 
1707  deaths  from  burns,  and  344  deaths  from  scalds,  making  in  all  2051  deaths  from 
these  causes.  They  are  thus  classified,  as  to  ages  and  sex: 


Causes  of 
Death. 

Under  1 
year. 

1 and  under 
5 years. 

5 and  under 
10  years. 

10  arid  under 
20  years. 

20  and  under 
50  years. 

50  and  under 
80  years. 

80  and  under 
100  years. 

100  years  and 
over. 

Total. 

Burns, 

Scalds, 

M.  F. 

71  73 
23  18 

M.  F. 

340  445 
149  94 

M.  F. 
104  245 
16  12 

M.  F. 

38  121 
7 — 

M.  F. 

83  101 
21  2 

M.  F. 
25  44 

1 1 

M.  F. 
8 8 

^ 1 
» I 1 

M.  F. 
669  1038 
217  127 

It  is  worthy  of  notice  that  369  more  females  were  burned  than  males,  while  90 
more  males  than  females  were  scalded.  The  greater  number  of  burns,  which  is 
apparent  during  each  period  but  one,  may  possibly  be,  in  part,  attributable  to  the 
inability  of  a female  to  escape  from  a burning  building,  or  vessel,  when  males 
are  able  to  do  so ; but  is  more  probably  due  to  the  difference  in  the  materials  and 


224 


OF  EMERGENCIES 


Drinking  hot  water. 


Inhaling  steam. 


A severe  and  extremely  dangerous  mode  of  scald- 
ing, is  that  caused  by  drinking  boiling  water,  or 
inhaling  hot  steam.  Children  sometimes  manage  to 
get  hold  of  a tea-kettle,  and  suck  either  the  steam  or 
hot  water,  contained  in  it.  At  other  times,  a sudden 
escape  of  steam,  at  a high  temperature,  from  a 
steam  engine,  fills  the  air  with  scalding  vapor,  and 
to  breathe  it  is  almost  certain  death.  Prevention  of 
the  accident  is  the  only  safe  course,  and  children 
should,  therefore,  be  early  taught  that  tea-kettles  are 
to  them,  forbidden  playthings.  If  a sudden  escape 
of  steam  is  the  cause  of  danger,  something  should 
be  immediately  thrown  over  the  head  of  the  child, 
even  if  it  is  no  more  than  a veil,  though  a thicker 
substance  is  more  desirable.  The  design  of  this  is 
to  keep  off  the  vapor  till  it  becomes  cooler,  which  is 

forms  of  dress,  of  the  two  sexes.  It  will  also  be  seen  that  after  the  age  of  ten, 
there  are  29  deaths  of  males  reported  as  caused  by  scalding,  and  only  3 of  females, 
which  is,  I suppose,  to  be  accounted  for  by  the  greater  exposure  of  men  to  acci- 
dents from  steam  escaping  from  steam  engines,  and  from  falling  into  boiling 
liquids  used  in  various  manufactures,  to  none  of  which  are  women  so  liable. 
V,\ra.mining  these  accidents  which  occurred  under  the  age  of  ten,  we  find  that  515 
boys,  and  763  girls,  died  of  bums,  while  188  boys,  and  124  girls  died  of  scalds.  Or, 
taking  the  differences,  we  have  248  more  girls  burned  than  boys,  which  is  a little 
* less  than  one-half  more,  while  64  more  boys  than  girls  were  scalded— which  is  a 
little  more  than  one-half  more.  The  more  constant  house  amusements  of  girls, 
and  their  cotton  garments  setting  off  from  their  limbs,  by  their  dryness  ready  to 
take  fire  at  the  first  touch  to  a hot  stove,  or  burning  coals,  must,  it  seems  to  me, 
account  for  this  great  difference  in  the  deaths  from  burns ; while,  on  the  other 
hand,  the  greater  strength,  and  the  clambering  propensities  of  young  boys,  expose 
them  to  fall  into  tubs,  or  to  bring  down  the  contents  of  tea-kettles  upon  them 
with  fatal  results.  This  is  farther  shown  by  the  fact,  that  60  more  boys  under 
five  years,  than  girls  of  the  same  age,  died  from  this  accident. 


OP  EMERGENCIES. 


225 


Results  of  these  injuries.  Small  burns  and  scalds. 

very  soon  the  case.  The  scalding  from  inhaling 
steam  is  most  dangerous,  for  the  hot  vapor  is  drawn 
into  the  windpipe,  even,  while  hot  water  taken  into 
the  mouth  is  not  usually  allowed  to  go  far  before  it 
is  spit  out.  Immediately  after  either  of  these  acci- 
dents, iced  water  and  small  pieces  of  ice  may  be  put 
into  the  mouth  as  constantly  as  possible,  but  there  is 
ground  for  the  worst  anticipations,  so  far  as  the  life 
of  the  child  is  concerned. 

Both  burns  and  scalds  are  often  followed  by  very 
great  disfiguration  of  the  patient,  and  this  in  spite 
of  the  most  skilful  treatment.  A knowledge  of  this 
fact  is  in  justice  due  both  to  the  mother  and  the 
physician,  that  the  latter  may  not  be  blamed,  improp- 
erly, if  deformity  results  from  the  accident,  and  that 
the  former  may  not  be  so  unwise  as  to  attempt,  her- 
self, to  direct  the  treatment  of  these  injuries,  when 
extensive. 

Small  burns  and  scalds  are  to  be  treated  on  the 
same  principle,  though  if  in  a convenient  position 
for  it,  as  on  the  fingers,  the  part  can  be  at  once 
plunged  into  cool  water  and  allowed  to  remain 
there  for  some  time.  When  taken  out  of  the  water, 
fine  carded  cotton  should'  be  put  over  it  to  prevent 
the  contact  of  the  air  in  the  mode  previously  directed. 

15 


226 


OP  EMERGENCIES. 


Cuts  with  sharp  and  dull  knives.  How  to  treat  wounds. 


Wounds , Sprains , Bruises,  and  Broken  Bones. 

Children  are  perpetually  meeting  with  these  acci- 
dents, and  they  are  all  worthy  of  thought  on  the 
part  of  the  mother.  It  is  often  sufficient  for  her  to 
know  what  to  do,  the  physician’s  advice  becoming 
necessary  only  for  the  grave  accidents. 

Wounds  made  with  a tolerably  sharp  knife  are 
much  more  inclined  to  bleed,  than  those,  which  from 
being  made  with  a more  blunt  or  dull  instrument, 
are  torn  rather  than  cut.  At  the  same  time  they 
often  heal  more  kindly,  and  are  less  apt  to  leave  a 
scar  behind  them.  If  a child  cuts  himself,  a soft 
sponge,  or  piece  of  soft  linen,  wet  with  cold  water, 
should  be  pressed  upon  the  wound  till  all  bleeding 
has  stopped,  and  as  soon  as  this  has  occurred,  its 
edges  may  be  brought  together  and  held  in  place, 
either  by  a narrow  strip  of  sticking  plaster — which 
by  the  way  it  is  well  to  have  constantly  in  the  house 
— or  by  some  other  variety  of  preparation  for  such 
uses.  Court  plaster  answers  very  well  for  quite 
small  cuts,  but  is  not  so  good  as  arnica  plaster,  which 
resembles  it  in  appearance,  but  is  not  so  apt  to  irri- 
tate the  wound  and  cause  it  to  fester.  Any  dirt,  or 
clots,  that  may  have  got  into  the  wound,  should  be 


OF  EMERGENCIES. 


227 


If  jets  of  blood  are  seen.  Treatment  of  sprains. 

carefully  washed  away  before  it  is  closed.  A 
ragged  wound  is  to  be  treated  in  the  same  way. 

, If  the  wound,  in  either  case,  is  deep,  the  sides  of  it 
should  be  supported  by  a bandage,  put  on  after  the 
application  of  the  plasters.  If  the  blood  comes  out 
of  some  of  the  vessels  divided  by  the  incision  in 
jets,  spirting  forcibly  to  some  distance  from  the  sur- 
face, the  mother  should  at  once  press  upon  the  skin 
directly  over  it,  in  such  a way  as  to  bring  it  between 
her  finger  and  the  bone  lying  nearest  under  it. 
After  holding  it  in  this  way  for  five  minutes,  the 
pressure  may  be  carefully  removed,  and  if  no  more 
bleeding  from  the  vessel  occurs,  the  wound  may  be 
done  up  as  before  directed.  Should  not  the  first 
attempt  suffice  to  stop  the  flow  it  may  be  repeated 
two  or  three  times,  but  if  the  blood  does  not  then 
stop,  the  pressure  should  be  steadily  continued  till 
the  surgeon  arrives. 

Sprains  are  most  frequently  met  with  in  the 
ankle  and  wrist  joints,  though  they  are  also  liable  to 
occur  in  every  joint  of  the  limbs.  The  joint  should 
at  once  be  rubbed  with  lard,  and  the  child  kept 
perfectly  still,  with  a piece  of  lint,  or  other  soft 
material,  constantly  wet  with  cool  water  upon  the 
joint.  If  the  swelling  becomes  very  great,  it  is 


228 


OP  EMERGENCIES. 


Treatment  of  bruises.  When  they  are  dangerous.  Broken  bones. 

better  to  send  for  the  surgeon,  because  what  is 
sometimes  supposed  to  be  a sprain,  is  in  fact  a dislo- 
cation, a bone  being  out  of  joint,  as  the  phrase  is.  , 
If  there  is  not  much  swelling,  but  a good  deal  of 
pain,  an  ounce  of  arnica  flowers  may  be  put  into  a 
pint  of  hot  water,  and  after  it  is  sufficiently  cool,  the 
joint  may  be  freely  bathed  with  the  water. 

Bruises  require  to  be  treated  in  the  same  manner 
as  sprains.  The  lard  is  an  item  of  moment,  for  it 
often  lessens  the  swelling  at  once,  and  there  is,  after 
its  use,  less  discoloration  from  settling  of  the  blood 
in  the  vicinity.  A bruise  is  of  importance,  chiefly 
according  to  its  locality.  It  is  those  about  the  head 
that  are  of  the  greatest  importance,  their  results 
sometimes  being  very  serious.  On  this  account,  if 
after  such  an  injury  the  child  does  not  seem  to  be 
entirely  well,  especially  if  it  should  have  a convul- 
sion, the  physician  should  be  at  once  consulted. 

Broken  bones  no  mother  would  think  of  treating, 
and  I only  say,  with  regard  to  them,  that  the  patient 
should  be  put  upon  a bed,  and  its  injured  limb  laid 
out  straight,  which  is  usually  the  most  comfortable 
position,  till  the  surgeon  arrives.  This  accident 
does  not  often  occur  to  children,  and  the  collar  bone 
is  the  one  that  is  most  frequently  broken. 


OF  EMERGENCIES. 


229 


Treatment  of  nose  bleeding. 


Treatment  of  earache. 


Bleeding  from  the  Nose. 

Blows  upon  the  nose,  or  falls,  in  which  this  organ 
is  struck,  often  cause  quite  severe  bleeding.  It  is 
well  to  bathe  it  in  cold  water,  repeatedly  renewing 
it,  and  pouring  it  particularly  upon  the  upper  part 
of  the  nose.  If  this  does  not  suffice,  a piece  of  ice 
may  be  held,  a little  while  at  a time,  between  the 
eyes.  Sometimes  firm  pressure  upon  the  sides  of  the 
nose,  between  the  eyes,  will  stop  the  flow  of  blood. 
When  such  means  fail,  alum  may  be  powdered  very 
finely,  and  blown  up  into  the  nostrils  through  a quill 
pointed  directly  upward,  after  being  passed  through 
the  opening.  Frequently  the  bleeding  is  from  one 
side  only,  and  then  remedies  should  of  course  be 
applied  to  that  alone. 

Earache . 

No  pain  is  much  more  severe  than  this,  it  being 
frequently  remembered  as  the  great  suffering  of 
childhood.  It  usually  is  caused  by  some  exposure  to 
cold  air.  The  ear  may  have  a lock  of  cotton,  that 
has  been  warmed,  placed  gently  in  its  passage, 
which  shutting  out  the  cold  air,  often  removes  the 
suffering.  If  this  does  not  do  it,  a little  sweet  oil 


230 


OF  EMERGENCIES. 


Poisoning.  Corrosive  sublimate. 

may  be  warmed  in  a spoon,  and  half  as  much  pare- 
goric then  be  mixed  wit’i  it.  Of  this  a drop  or  two 
may  be  allowed  to  run  down  into  the  ear,  it  usually 
giving  entire  relief  from  the  pain.  I have  before 
stated  that  no  fear  need  be  entertained  that  it  will 
penetrate  to  the  brain. 


Various  substances  which  are  poisonous  are  in 
common  use,  and  if  carelessly  left  within  reach  of 
children,  will  sometimes  be  taken  by  them.  Occa- 
sionally a medicine,  which  in  the  proper  dose  would 
be  beneficial,  is  given  in  too  large  quantity,  and  thus 
becomes  poisonous,  while  various  plants,  which  grow 
almost  everywhere,  are,  if  eaten,  injurious  in  the 
same  way.  Prevention  by  keeping  these  things  out 
of  reach,  is  of  course  a wise  precaution,  but  after 
all  “ accidents  will  happen  in  the  best  regulated 
families.”  The  following  are  the  remedies  for  the 
most  common  poisons.  For  most  of  them,  immedi- 
ate action  is  required,  and  though  the  physician 
should  be  at  once  sent  for,  the  mother  should  not 
remain  inactive. 

Corrosive  sublimate  is  one  of  the  substances  most 
frequently  poisoning  children  fatally.  Its  popular 


OP  EMERGENCIES. 


231 


Remedy  for  corrosive  sublimate.  Alcohol. 

use  as  a “ bedbug  poison,”  introduces  it  into  many 
families,  and  especially  to  those  who  are  ignorant 
of  its  dangerous  properties.  It  is  also  more  fre- 
quently left  within  reach  of  children  than  other 
dangerous  preparations,  while  the  want  of  color  in 
the  solution,  does  not  enable  the  child  to  see  that  it 
is  not  water.  A quantity  is  sometimes  thus  drunk, 
before  the  child  is  noticed.  The  remedy  is,  to 
make  the  child  immediately  swallow  the  raw  white 
of  eggs,  or  if  he  will  not  take  this,  the  yolk  and  all 
may  be  beaten  up  together  in  a little  milk  slightly 
sweetened,  and  given.  The  more  of  this  that  he 
takes,  the  better,  and  if  possible,  the  white  of  at 
least  six  eggs  may  be  thus  given.  After  it  has  been 
all  swallowed  a few  minutes,  say  fifteen,  a strong 
emetic  of  mustard  and  water  should  be  given,  to 
throw  off  the  egg,  which  entangles  the  poison.  The 
accident  is  a serious  one,  and  much  depends  on  the 
promptness  with  which  the  raw  eggs  are  given. 

Alcohol , in  whatever  form,  if  swallowed  in  consid- 
erable quantity,  requires  a prompt  emetic,  either  of 
mustard  and  water,  or  of  salt  and  water,  to  be 
given,  and  as  soon  as  the  stomach  is  emptied,  as 
much  water  may  be  given  as  the  patient  can  be 
induced  to  take. 


232 


OP  EMERGENCIES. 


Acids.  Alkalies.  Phosphorus. 

Acids , whether  oil  of  yitriol  (sulphuric  acid),  or 
aqua-fortis  (nitric  acid),  or  oxalic  acid,  do  not  often 
come  in  the  way  of  children  so  as  to  be  swallowed. 
When  they  are  taken,  the  patient  should  be  made  to 
drink,  as  soon  as  possible,  a strong  soap  suds,  made 
of  any  soap,  hard  or  soft,  that  is  nearest  at  hand. 
Meantime  some  prepared  chalk,  in  fine  powder,  or 
magnesia,  should  be  mixed  with  a little  water, 
to  be  taken  as  soon  as  it  is  ready.  If  the  soap 
does  not  produce  vomiting„a  mustard  emetic  may  be 
given  some  time  after  the  chalk  has  been  taken. 
These  poisons,  however,  if  strong,  destroy  the  parts 
touched  by  them,  and  of  course  the  remedies  sug- 
gested, cannot  restore  them.  They  are  designed  to 
neutralize  and  remove  any  that  may  remain  in  the 
stomach. 

Alkalies  are  not  often  swallowed  by  children,  the 
chief  exposure  being,  when  lye  is  made  from  ashes, 
or  a solution  of  potash  is  at  hand  for  the  manufac- 
ture of  soap.  The  treatment  is  to  give  vinegar,  or 
some  kind  of  oil,  either  castor,  lard,  olive,  or  linseed 
oil  doing  equally  well.  The  oil  and  vinegar  may  be 
given  alternately,  and  in  large  quantities. 

Phosphorus  may  be  taken  by  eating  the  ends  of 
matches,  or  by  eating  bread  on  which  rat  poison,  in 


OP  EMERGENCIES. 


233 


Arsenic.  Laudanum.  Poisonous  seeds. 

which  this  is  a -hief  ingredient,  has  been  spread. 
Chalk  and  magnesia  may  be  given,  as  directed  for 
acids. 

Arsenic  requires  milk  to  be  taken  freely,  and  free 
vomiting  should  be  produced  by  giving  either  a 
mustard  or  salt  emetic.  If  milk  is  not  conveniently 
at  hand  in  sufficient  quantity,  give  wheat  flour  and 
water,  mixed  together. 

Laudanum  — Opium  in  excess,  whether  given  m 
this  form,  or  in  paregoric,  or  McMunn’s  elixir,  or 
Dalby’s  carminative,  or  in  other  ways,  requires  the 
same  treatment.  A prompt  emetic  is  the  first  thing 
to  be  given,  and  mustard  or  salt  may  be  tried.  The 
trouble  is,  that  it  is  difficult  to  produce  any  effect  by 
them,  the  stomach  acting  sluggishly  from  the  pres- 
ence of  the  narcotic.  A dose  of  sulphate  of  zinc 
(white  vitriol)  may  therefore  be  obtained  and  given. 
The  patient  should  be  kept  walking  about,  or  roused 
in  some  way;  striking  with  rods,  dashing  cold 
water  in  the  face,  and  similar  methods,  must  be  con- 
stantly practised  till  the  physician  arrives. 

Poisonous  seeds  and  plants  of  various  kinds,  are 
eaten  by  children,  and  require,  so  far  as  the  mother 
is  concerned,  the  same  treatment.  The  most  com- 
mon of  these  are  the  stramonium,  known  as  the 


234 


OF  EMERGENCIES. 


Stings  of  insects. 

lamestown  weed  (corrupted  into  Jimsen  weed),  or 
horn  apple,  and  conium,  known  as  poison  hemlock. 
A prompt  emetic  is  the  remedy,  and  when  mustard 
and  salt  fail,  a more  powerful  one  should  be 
obtained  from  a druggist.  There  is  so  much  danger 
from  this  cause,  that  especial  pains  should  be  taken 
to  destroy  all  the  plants  which  grow  in  the  vicinity 
of  dwellings.  Several  garden  plants  are  poisonous, 
but  the  same  treatment  is  required  when  they  are 
eaten. 

Stings  of  Insects . 

These  are  not  often  very  serious,  though  of 
common  occurrence.  From  the  most  common,  as 
mosquito  bites,  to  those  which  are  more  serious,  as 
the  stings  of  large  bees,  the  best  remedies  are 
cologne  water,  spirits  of  hartshorn  (ammonia),  tinc- 
ture of  camphor.  The  insect  sometimes  breaks  off 
his  sting  in  the  flesh,  or  it  is  left  when  he  is  killed 
in  the  very  act.  It  is,  therefore,  well  to  look  for 
this.  It  is  known  by  the  black  dot  in  the  middle  of 
the  poisoned  spot.  This  can  be  seized  by  delicate 
forceps  and  pulled  out.  If  it  remains,  the  worst  is, 
an  increase  of  the  soreness  of  the  sting,  and  a for- 
mation of  matter,  by  which  its  discharge  is  after 
some  time  accomplished. 


OF  EMERGENCIES. 


235 


Disappearance  of  eruptions. 


.Repelled  Eruptions . 

When  in  the  course  of  an  eruptive  disease,  like 
measles,  the  eruption  disappears  suddenly,  convul- 
sions may  follow.  It  is  then  necessary  to  give  the 
patient  a warm  bath,  increasing  the  temperature  till 
it  is,  in  fact,  hot.  This  is  the  most  ready  restorer 
of  the  eruption,  which  is  the  first  necessity.  Saffron 
tea,  which  is  a popular  remedy,  does  no  particular 
good,  but  it  does  no  harm,  unless  it  is  trusted  to  the 
exclusion  of  the  warm  bath.  A vigorous  action  of 
the  skin,  thus  excited,  generally  brings  it  out  again. 


236 


APPENDIX. 


Wine  whey. 


APPENDIX. 

DIETARY. 

For  the  convenience  of  those  who  may  be  at  a 
loss  for  directions  concerning  the  preparation  of 
various  articles  of  food,  recommended  in  the  preced- 
ing pages,  or  of  occasional  use  in  the  nursery,  I have 
added  the  following  receipts,  gathered  from  different 
sources,  and  all  of  practical  value. 

Wine  Whey. — Take  equal  quantities  of  milk, 
water,  and  wine,  and  set  the  milk  and  water  over 
the  fire  until  it  boils,  then  add  the  wine,  allowing  it 
to  boil  for  a moment,  stirring  it.  Take  out  the  curd 
and  sweeten  the  whey  to  your  taste.  When  cool,  it 
is  ready  for  use.  This  is  for  children  during  the 
first  year.  As  the  child  grows  older,  omit  the 
water. 


APPENDIX. 


237 


Milk  punch.  Beef  tea.  Beef  soup.  Chicken  broth. 


Milk  Punch. — To  a gill  of  milk  add  a teaspoonful 
of  brandy,  with  a teaspoonful  of  loaf  sugar. 

Beef  Tea . — Take  about  half  a pound  of  tender 
beef  and  put  it  into  a saucepan,  with  water  enough 
to  cover  it  well.  Let  it  boil  slowly  for  about  half 
an  hour,  then  skim  it  carefully  and  pour  off  the 
liquor,  adding  a very  little  salt. 

Beef  Soup  is  made  much  in  the  same  way  as  beef 
tea,  but  it  must  boil  about  an  hour  and  a half  or 
two  hours,  adding  a little  rice  about  half  an  hour 
before  taking  it  off  the  fire. 

Chicken  Broth  is  made  by  taking  about  a third  of 
a chicken,  covering  it  well  with  cold  water,  putting 
in  a little  salt,  and  letting  it  boil  for  two  hours, 
skimming  it  very  carefully  and  putting  in  either  a 
little  rice  or  pearl  barley,  about  half  an  hour  before 
taking  it  up. 

Beef  Essence . — Take  a pound  of  meat,  carefully 
separated  from  the  fat,  chop  it  as  fine  as  possible, 
pour  upon  it  half  a pint  of  cold  water  and  mix  i 


238 


APPENDIX. 


Beef  essence.  Stewed  oysters. 

well ; let  it  stand  an  hour,  stirring  three  or  four 
times,  and  then  press  out  all  the  fluid.  Pour  another 
half  pint  of  cold  water  on  the  meat,  mix  as  before, 
and  let  it  stand  with  occasional  stirring  for  half  an 
hour,  when  the  fluid  is  to  be  again  pressed  out  of 
the  meat.  Then  put  the  meat  into  a small  covered 
tin  dish,  which  is  to  be  put  into  a saucepan  or  simi- 
lar vessel,  with  cold  water  in  it,  coming  two-thirds  of 
the  way  up  the  side  of  the  dish  that  holds  the  meat. 
Put  the  sauce  pan  on  the  fire  so  that  the  water  will 
gradually  heat  till  it  boils,  and  the  boiling  may  be 
allowed  to  continue  for  twenty  minutes.  A fluid 
will  exude  from  the  meat,  and  this  is  again  to  be 
pressed  out  of  it.  Mix  now  the  three  fluids,  add- 
ing a little  salt,  and  boil  them  together  about  twenty 
minutes  in  a covered  vessel.  During  the  last  boil- 
ing, rice  may  be  added  if  desired.  The  fluid 
obtained  in  this  way  often  requires  to  be  reduced 
for  children  by  the  addition  of . hot  water,  but  it 
contains  the  nutritious  elements  in  a more  digestible 
condition  than  most  other  preparations.  Other 
meats  can  be  treated  in  the  same  way. 

Stewed  Oysters. — Put  the  oysters  into  a saucepan 
and  let  them  simmer  about  fifteen  minutes.  If  any 


APPENDIX. 


239 


Beef  steak.  Broiled  chicken.  Boiled  rice.  Fried  rice. 


scum  rises  take  it  off.  For  young  children,  they 
should  not  be  seasoned  at  all,  as  they  are  salt  enough 
of  themselves,  and  are  too  rich  if  butter  or  flour  is 
added.  When  given  to  the  child  crumb  in  a little 
stale  bread,  and  take  out  the  hard  part  of  the 
oyster. 

Beef  Steak. — Get  a small  piece  of  tender  steak, 
the  tenderloin  is  best,  and  put  it  upon  the  gridiron 
over  a quick  fire,  so  that  it  will  not  be  dried  up, 
and  cook  it  rarely,  adding  a very  little  salt.  No 
butter  or  pepper  is  required  for  a child. 

Broiled  Chicken , should  be  cooked  in  the  same 
manner  as  the  beef  steak,  only  a little  longer,  and 
seasoned  only  with  salt.  The  skin  of  the  chicken 
should  not  be  given  to  the  child.  t 

Boded  Rice. — To  half  a cup  of  rice  put  a pint  of 
cold  water  and  a very  little  salt.  Boil  it  about 
twenty  minutes,  then  pour  off  the  water,  add  about 
half  a cup  of  rich  milk,  and  let  it  boil  about  fifteen 
minutes  longer. 


Fried  Rice. — The  rice  should  be  boiled  in  the  same 


240 


APPENDIX. 


Sweet  potatoes.  Arrowroot.  Com  starch 

way  as  before  mentioned,  omitting  the  milk,  and 
when  cold  should  be  cut  in  thin  slices.  Then  rub 
a little  butter  on  the  griddle,  just  enough  to  prevent 
the  rice  from  sticking,  but  not  so  as  to  make  it  at  all 
fatty,  and  lay  on  the  slices,  browning  them  on  both 
sides.  It  may  be  eaten  with  or  without  sugar,  as 
the  child  prefers. 

Sweet  Potatoes. — These  are  usually  relished  by 
children,  and  are  very  wholesome  if  carefully  baked 
so  as  to  be  soft  and  dry,  when  they  should  be 
mashed,  and  a little  milk  or  sweet  butter  put  with 
them,  together  with  a little  salt.  With  most  chil- 
dren these  are  more  digestible  than  white  potatoes, 
particularly  if  there  is  a tendency  to  diarrhoea. 

Arrowroot. — To  a teaspoonful  of  arrowroot  put 
a cup  of  milk.  When  the  milk  is  boiling,  mix  the 
arrowroot  with  a little  water  to  form  a smooth 
paste,  and  put  it  into  the  milk,  stirring  it  carefully 
for  several  minutes  so  that  it  may  have  no  lumps. 
Then  take  it  from  the  fire  and  add  a little  salt,  and 
sugar  if  agreeable  to  the  child. 

Com  Starch  is  prepared  in  the  same  way  as  arrow- 
root. 


APPENDIX. 


241 


Sago.  Wheat  gruel.  Toast  water. 


“ Lait  de  poule.” 


Sago. — Wash  a large  spoonful  of  sago,  boil  it  in 
a little  water  with  a pinch  of  salt  and  one  or  two 
sticks  of  cinnamon  until  it  looks  clear,  then  add  a 
pint  of  milk,  boil  all  well  together,  and  sweeten 
with  loaf  sugar. 

Wheat  Gruel. — Tie  half  a pint  of  wheat  flour  in  a 
thick  cotton  cloth,  and  boil  it  three  or  four  hours  ; 
then  dry  the  lump,  and  grate  it  when  you  use  it. 
Prepare  a gruel  of  it  by  making  a thin  paste  and 
pouring  it  into  boiling  milk  and  water,  and  flavor 
with  salt.  This  is  good  for  teething  children. 

Toast  Water. — Toast  bread  very  brown  and  put  it 
into  a glass  of  cold  water.  This  is  often  relished 
by  children  when  much  water  is  not  allowed. 

“ Lait  de  Poule  ” — This  is  frequently  used  by  the 
French,  and  is  of  occasional  use  in  this  country.  It 
is  made  by  beating  up  the  yolk  of  an  egg  in  half  a 
pint  of  water,  and  sweetening  it  with  a little  refined 
sugar.  # 

Isinglass  Jelly. — To  an  ounce  of  shaved  isinglass 

16 


242 


appendix. 


Tapioca  jelly. 

Isinglass  jelly.  

put  a quart  of  water,  boil  it  down  to  a pint  and 
strain  it  through  a flannel  bag ; add  a little  sugar 
and  a very  little  wine — just  enough  to  flavor  it 
and  set  it  away  to  cool.  Jelly  made  of  the  Ameri- 
can gelatine  is  most  excellent,  and  upon  the  paper 
directions  for  preparing  it  are  found,  but  for  young 
children  the  lemon  should  be  omitted  and  but  little 
wine  used  — not  more  than  one-fourth  the  quantity 
directed.  This  is  not  to  be  depended  on  to  nourish 
the  child. 

Tapioca  Jelly.—  Take  half  a cup  of  tapioca,  wash  it 
two  or  three  times,  and  soak  it  in  water  for  five 
hours.  Then  simmer  it  in  the  same  water  in  which 
it  has  been  soaked,  with  a pinch  of  salt  and  a little 
cinnamon,  until  it  becomes  nearly  transparent.  Then 
put  in  it  a little  loaf  sugar,  and  pour  it  into  glasses 
to  cool. 


INDEX 


Accumulation  of  urine  during  preg- 
nancy, 19. 

Acidity  of  the  stomach,  17. 

Acids,  232. 

Age  of  the  wet  nurse,  62. 

Air  of  the  bedroom  to  be  pure,  114. 
Alcohol,  231. 

Alkalies,  232. 

Anxiety  of  no  use,  13. 

Apparatus  for  artificial  feeding,  72. 
Arrowroot,  240. 

“ objectionable,  39. 

Arsenic,  poisoning,  by,  233. 

Artificial  feeding,  64. 

“ “ for  a few  days,  39. 

“ “ imitate  nature  in  posi- 

tion, 73. 

Ass’s  milk.  64. 

Attention  necessary  with  the  best  appa- 
ratus for  artificial  feeding,  77. 
“ to  the  condition  of  the  bowels 
during  dentition,  87. 
Bathing  during  pregnancy,  20. 

“ in  too  cold  water  injurious,  48. 
“ the  child,  47. 

Beans,  121. 

Bedding,  46, 113. 

Beef  essence,  237. 


Beef  soup,  237. 
steak.  239. 
tea,  237. 

Beer,  ale,  &c.,  for  nurses,  63. 

Belly  band,  36. 

Benefits  of.  chloroform  in  labor,  29. 

Bile  in  matters  vomited,  148. 

Birth  of  the  child  in  absence  of  the 
physician,  25. 

Bleeding  from  gums,  how  stopped,  85. 

from  the  mother  after  confine- 
ment, 29. 

from  the  nose,  229. 

Blood  in  the  stools,  152. 

Boiled  milk  in  diarrhoea,  158. 

rice,  239. 

Boiling  milk,  67. 

Bowels  affected  by  teething,  100. 

“ by  warm  weather,  100 
condition  during  teething,  86. 
of  the  mother  to  be  open,  15. 
Brain,  early  signs  of  disease  of,  143. 
Bread  for  weaned  children,  107. 
Breathing,  how  established,  28. 

Broiled  chicken,  239. 

Bronchitis,  how  it  may  be  caused,  112. 
Broths,  107. 

Brown  mixture  for  coughs,  166. 


244 


INDEX 


Bruises,  their  treatment,  228. 

Burning  clothes,  how  extinguished,  220. 
Burns,  219. 

“ followed  by  disfiguration,  225. 

“ “ by  prostration,  222. 

“ how  prevented,  222. 

“ their  treatment,  220. 

Bone3,  treatment  when  broken,  228. 
Buttons,  treatment  after  swallow- 
ing, 218. 

Calf’s  teats,  75. 

Candy,  121. 

“ how  it  injures  the  teeth,  123. 
Carron  oil  for  burns,  221. 

Cathartics  in  convulsions,  208. 

“ in  diarrhoea,  154. 

“ not  necessary  usually,  39. 

Causes  of  vomiting,  147. 

Chalk  mixture,  161. 

Change  necessary  for  the  corks  in  nurs- 
ing bottles,  74 

Change  of  food  affects  the  bowels,  100. 
Change  of  diet  should  be  gradual,  103. 
Checking  vomiting,  149. 

Chicken  broth,  237. 

“ pox,  211. 

Child-birth  is  a natural  function,  22. 
Children  to  be  controlled  in  diet,  110. 

“ must  obey,  95. 

Child’s  position  while  feeding,  76. 
Chloroform  during  confinement,  29. 
Choking,  symptoms  and  treatment 
of,  214. 

“ two  ways  of,  213. 

Cholera  infantum,  162. 

Cleaning  the  teeth,  119. 

Coffee  and  tea,  109. 

Coins  in  the  windpipe,  217. 

Cold  applications  to  the  head,  192. 

“ feet,  138. 

“ water  unfit  for  bathing,  48. 

Colds,  ordinary  ones,  163. 

Confinement  not  sickness,  23. 
Connection  between  the  mother  and 
child,  14. 


Contrast  between  health  and  sick- 
ness, 133. 

Constitution  depends  on  the  mother,  12. 
Constipation  of  the  mother  during  preg- 
nancy, 15. 

“ relative,  150. 

“ relieved  by  injections,  16. 

“ “ by  coarse  food,  16. 

“ treated  by  pills,  16. 
Convulsions,  198. 

“ at  the  close  of  dis- 
eases,  212. 

“ during  dentition,  88. 

“ preceding  eruptions,  209. 

“ premonitory  symptoms 
of,  202. 

“ prevention  of,  206. 

“ treated  by  cathartics,  208. 

“ treatment  of,  203. 

“ warm  bath  for,  204. 

“ when  emetics  are  u 


ry,  207. 

Cooking  in  the  sick  room,  182. 
Cord,  how  to  cut  it,  27. 

“ how  to  tie  it,  26. 

Corn  starch,  240. 

Corrosive  sublimate,  230. 
Cotton  for  burns,  221. 

Coughs,  163. 

Cough  of  croup,  170. 


Cow’s  milk,  66. 

Cow,  new  milch  preferable,  66. 

Cracker  water  objectionable,  39. 

Cream  for  feeding  children,  69. 
Creeping,  the  dress  while,  90. 

Croup,  169. 

“ two  kinds  of  it,  170. 

Crying  not  necessarily  dangerous,  95 
Curds  in  the  discharges,  154. 

Currents  of  air  to  be  avoided,  115. 
Cutting  the  cord,  27. 

“ the  gums,  84. 

Danger  of  cold  from  riding  in  low  wag 
ons,  92. 


INDEX 


245 


Deaths  from  scalds  and  burns,  223 
Definition  of  convulsion,  200. 

“ of  spasm,  201. 

Deformities,  37. 

Delicate  infants,  diet  for,  70. 

Dentition,  its  order  and  period,  81. 
Depressing  effect  of  cold,  51. 
Description  of  the  best  nurse  tube,  76 
Diarrhoea  during  teething,  87. 

“ in  the  mother,  18. 

“ its  treatment,  155. 

“ its  varieties,  152 

“ prescription  for,  161. 

Diet,  changes  should  he  gradual,  103. 

“ during  colds,  167. 

“ “ pregnancy,  14. 

“ for  weaned  children,  107. 

“ in  diarrhoea,  157. 

“ of  children  after  two  years,  120. 

“ “ “ to  be  varied,  108. 

“ when  changed  affects  the  bow- 
els. 100. 

Disfiguration  after  burns,  225. 

Dress,  124. 

“ during  the  first  month,  50. 

“ in  colds,  164. 

“ of  children  during  the  second 
year,  111. 

“ when  riding,  112. 

“ when  to  shorten  it,  90. 

Dressing  the  child  the  first  time,  34. 

“ the  cord,  35. 

Dried  fruits,  121. 

Drinking  hot  water,  224. 

Drinks,  109. 

Duties  of  a mother  to  the  child  before 
birth,  13. 

Dysentery,  162. 

Dyspepsia,  its  causes,  122. 

Earache,  229. 

Early  dentition,  79. 

“ nursing  beneficial  to  both  child 
and  mother,  38. 

Earwigs,  219. 

Ears,  substances  in  the,  218. 


Eating  between  meals,  122. 

Eau  Sucree,  109. 

Education  of  children,  115. 

“ physical,  126. 

Effect  of  mental  emotions  during  preg- 
nancy, 21. 

“ on  the  child,  of  scanty  diet,  15. 
Eggs,  107. 

Emergencies,  198. 

Emetics  in  convulsions,  207. 

Eruptions  from  use  of  soap,  50. 

“ preceded  by  convulsions,  209. 

‘ repelled,  235. 

Ether  during  confinement,  29. 

Excessive  vomiting,  148. 

Exercise  during  pregnancy,  20. 

“ of  infants,  93. 

Exertion  beneficial  for  the  child  in 
drawing  milk  from  a bottle,  75. 
Exhaustion  from  excessive  nursing,  41. 
Exposure  from  following  fashion,  111. 

“ from  insufficient  dress,  125. 

Eyebrows  may  indicate  disease,  144. 

Eye  teeth,  when  they  come,  81. 

Eyes,  expression  of  in  sickness,  143. 

“ half  shut  do  not  show  dis- 
ease, 144. 

Face  indicates  sickness,  140. 

Fashionable  dress,  125. 

Fashion  an  unsafe  guide,  52. 

Feeding  artificially,  64. 

Feeding  child  to  be  carefully  watched 
during  dentition,  89. 

Feeding  infants  from  cups  objection- 
able, 78. 

Feet,  cold,  138. 

“ of  children  to  be  kept  warm,  91. 
Female  physicians,  25. 

Fire,  how  to  put  out  burning 
clothes,  220. 

“ in  the  sleeping  room,  114. 

Fish,  107. 

“ bones  in  the  throat,  217. 

Fits,  198. 

Flannel  to  be  worn  over  the  bowels,  162. 


246 


INDEX 


Flowing  from  the  mother,  how  to  he 
treated,  28. 

Flour  for  burns,  221. 

Flushing  not  blushing,  142. 

Food  during  sickness,  195. 

“ undigested,  in  the  discharges,  153. 
Fresh  air  important,  114. 

“ **  necessary  to  the  infant,  53. 

Fried  rice,  240. 

Fruits  for  children  objectionable,  109. 
Goat,  how  tp  select  one,  65. 

Goat’s  milk,  65. 

Green  com,  121. 

11  discharges  from  the  bowels,  152. 
Grinding  teeth,  when  they  come,  81. 
Gums,  appearance  of  in  a healthy  child 
while  teethirg,  82. 

“ how  to  cut  them,  84. 

“ how  to  stop  bleeding  from 
them,  85. 

11  sometimes  the  seat  of  severe 
pain,  83. 

Habits,  127. 

“ easily  acquired,  41. 

“ to  be  cultivated  during  the  sec- 
ond six  months,  96. 

Habit  of  movement  of  the  bowels,  17. 
Hands,  their  position  to  be  noticed,  134. 

“ when  not  to  be  noticed,  135. 
Hardening  process,  50. 

Head,  hot  in  sickness,  136. 

“ how  to  apply  cold  to  it,  192. 

Heat  indication  of  sickness,  134. 

“ of  the  abdomen,  138. 

“ of  the  chest,  138. 

Hive  syrup,  173. 

Hot  hands,  135, 
u head, 136. 

How  often  the  child  may  nurse,  41. 

“ to  wean  the  child,  104. 

Hygienic  care  of  children  between  six 
and  twelve  months  old,  92. 

Ice  for  cooling  the  head,  194. 

“ in  diarrhoea,  160. 

“ in  excessive  vomiting,  149. 


n of  the  mother’s  milk,  69. 
Importance  of  noticing  the  position  of 
the  sick  child,  139. 

In  case  of  doubt  send  for  the  physi 
cian,  130. 

India-rubber  nipples,  75. 

Infants  to  be  carried  by  the  nurse,  92. 
Influence  of  longings,  12. 

Inhaling  hot  steam,  224. 

Injecting  syringes,  190. 

Injections,  187. 

for  constipation,  188. 
for  diarrhoea,  19,  187. 
for  mothers  during  pregnan- 
cy, 16. 

how  to  give  them,  191. 
in  convulsions,  205. 
repetition  of,  for  constipa- 
tion, 151. 

Injurious  effects  of  bathing  in  cold 
water,  47. 

“ to  the  child  of  sleeping 
with  the  mother,  45. 
“ of  too  much  soap  in 
bathing,  49. 

Insects,  stings  of,  234. 

Interval  between  meals,  43. 

Intolerance  of  noise  and  light,  146. 
Inward  fits,  199. 

Ipecacuanha,  173. 

Isinglass  jelly,  241. 

Jaw,  teeth  in  the  lower,  that  come 
first,  80. 

Jellies  not  nutritious,  159. 

Jelly,  isinglass,  241. 

tapioca,  242. 

Knowledge  of  disease  sometimes  unde- 
sirable, 131. 

Lait  de  poule,  241. 

Lancing  the  gums,  84. 

Laudanum,  233. 

Light  beneficial  to  infants,  54. 

in  the  sick  room,  180. 

Little  upon  little,  127. 

Local  spasms,  212. 


INDEX 


247 


Lung  fever,  176. 

Making  the  child  breathe,  28. 

Manner  of  weaning,  106.  # 

Marks,  11. 

Material  of  the  tube  of  nursing  bot- 
tle, 75. 

Materials  for  infants’  dresses,  61. 

Meals  to  be  regular,  123. 

Measles,  210. 

" the  cough  of,  169. 

Meats,  107. 

Medicines,  how  to  give  them,  183. 

“ not  to  be  concealed  in 
food,  184. 

Menstruating  while  nursing,  104. 
Mental  and  moral  constitution  affected 
by  the  mother,  12. 

“ emotions  during  pregnancy,  21. 
Middle  teeth  of  each  jaw,  80. 

Milk,  difference  in  that  of  different  ani- 
mals, 68. 

“ of  the  wet  nurse  to  be  of  the  same 
age  with  the  mother’s,  60. 

“ punch,  237. 

“ to  be  sweet,  67. 

Mixture  for  diarrhoea,  161. 

Mother’s  diet  during  pregnancy,  14. 

“ influence  on  the  child’s  consti- 
tution, 12. 

“ marks,  11. 

“ not  doctors,  129. 

Mouth  indicates  disease,  141. 

Nausea,  how  indicated,  141. 

Neglect  of  moral  culture  culpable,  128. 
Nervous  system  affected  by  teething,  88. 
Night  caps,  91. 

“ clothes  of  the  infant,  53. 

“ dress,  126. 

Nipple  to  be  dried  after  nursing,  38. 
Nipples  of  india-rubber,  75. 

Nose  bleeding,  229. 

“ indicates  disease,  142. 

“ substances  in  the,  218. 

Nurse  for  the  month,  23. 

“ (wet),  how  to  be  selected,  59 


Nurses  (wet),  when  necessary,  56. 

“ duties  when  the  child  is  born  be- 
fore the  physician  arrives,  26. 
“ duties  when  there  is  flowing 
from  the  mother,  29. 

Nursing  apparatus  to  be  kept  sweet,  73. 
“ bottle  and  tube,  the  best,  76. 

“ “ to  be  easily  cleaned,  74. 

“ for  the  first  time,  37. 

“ not  to  be  too  frequently  re- 
peated, 41. 

“ while  menstruating,  104. 

“ “ pregnant,  105. 

Nuts,  121. 

Odors  in  the  sick  room,  181. 

Oil,  Carron  for  burns,  221. 

“ for  burns,  220, 

Oysters,  107. 

Pain  caused  by  teeth  pressing  on  the 
gums,  83. 

Palms  of  the  hands  hot,  135. 

Panada  objectionable,  39. 

Partial  convulsions,  212. 

“ weaning,  92. 

Permanence  of  early  impressions,  128. 
Phosphorus,  232. 

Physical  constitution  influenced  by  the 
mother,  12. 

“ education,  126. 

Physician,  his  qualifications,  24. 

Pickles,  121. 

Pills  for  constipation,  16. 

Pins,  treatment  after  swallowing,  218. 
Pleurisy,  176. 

Pneumonia,  176. 

Poisoning  by  acids,  232. 

“ alcohol,  231. 

“ alkalies,  232. 

“ arsenic,  233. 

“ corrosive  sublimate,  230. 

“ laudanum,  233. 

“ phosphorus,  232. 

Poisonous  seeds,  233. 

Poisons,  230. 

Position  of  sick  children  important,  139. 


248 


INDEX 


Position  of  the  hands  in  different  dis. 

eases,  133. 

Potatoes,  107. 

“ sweet,  240. 

Powders  for  the  teeth  of  children,  120. 
Precautions  for  avoiding  croup,  175. 
Precocity  not  to  be  desired,  115. 
Pregnancy,  accumulation  of  urine  dur- 
ing it,  19. 

“ bathing  during,  20. 

“ with  diarrhoea,  19. 

“ while  nursing,  105. 

Pregnant  mother  not  to  starve  her- 
self, 15. 

“ mother’s  most  perfect  con- 
dition. 15. 

Premonitory  symptoms  of  convul- 
sions, 202. 

Prescription  for  constipation,  16. 

“ for  diarrhoea,  161. 

“ “ “ in  the  moth- 

er, 19. 

Prevention  of  convulsions.  206. 
Proportions  of  cream,  water,  and  sugar 
for  the  first  month,  40. 

Prostration  after  burns,  222 

Pure  air  important  in  the  bed  room,  114 

Quiet  in  diarrhoea,  160. 

“ in  the  sick  room,  179. 

“ necessary  for  the  mother  after 
confinement,  31. 

Regurgitation  not  vomiting,  43,  147. 
Religious  influence  of  the  mother,  128. 
Remedy  for  cold  feet,  139. 

Removal  of  odors  in  the  sick  room,  181. 
Repelled  eruptions,  235. 

Rhubarb  in  diarrhoea,  161. 

Rice,  107. 

“ boiled,  239. 

“ fried,  240. 

“ why  beneficial  in  diarrhoea,  158. 
Rolling  the  eyes  no  evidence  of  dis- 
ease, 144. 

“ the  head  in  sickness,  140. 

Rose  rash,  210. 


Rule  for  the  infant’s  walks,  54. 

Rules  concerning  weaning,  101. 

for  selecting  apparatus  for  artifi- 
cial feeding,  73. 

Ruling  the  child,  95. 

Sago,  241. 

Saint  Vitus’  dance.  213. 

Scalding  by  steam,  224. 

Scalds,  219. 

followed  by  disfiguration,  225. 
why  more  dangerous  than 
burns,  223. 

Scarlet  fever,  209. 

Second  six  months,  79. 

summer,  why  dangerous,  100. 
year,  98. 

in  the  windpipe,  217. 
poisonous,  233. 

Selection  of  a monthly  nurse,  23. 
of  a wet  nurse,  59. 
of  the  physician,  24. 
of  the  room  for  sickness,  178. 
Shedding  tears  while  sick,  145. 

Sickness,  giving  food  during  it,  195. 

shown  by  change  of  color,  142 
“ by  the  eyes,  143. 

“ by  the  eyebrows,  144. 

“ by  the  face,  140. 

“ by  the  features,  141. 

“ by  the  hands,  135 

“ by  the  heat  of  the  chest, 
138. 

“ by  the  position,  139. 

“ by  rolling  the  head,  140. 
“ by  the  temperature  of 
the  head,  136. 
selection  of  room  in,  178. 

Sick  room,  cooking  in  it,  182. 

its  management,  177. 

Signs  of  sickness,  132. 

Silver  nurse  tubes  the  best,  76. 

Sleeping  with  the  mother  to  be  forbid- 
den, 44. 

Small  pox,  211. 

Soap  in  bathing,  49. 


INDEX 


249 


Soap  injections,  189. 

Sour  stomach,  17, 150. 

Spasmodic  croup,  171. 

“ croup,  treatment  during  the 
intervals,  174. 

Spasms,  201. 

« “ local,  212. 

Spiced  food,  121. 

Spirituous  liquors  for  curses,  63. 

Sponge  bath,  49. 

Sponges  objectionable  for  nursing  bot- 
tles, 74. 

Spoon  feeding  objectionable,  78. 

Sprains,  their  treatment,  227. 

Statistics  of  deaths  from  burns,  223. 
Steam,  inhaling  it  when  hot,  224. 

Stewed  oysters,  238. 

Stings  of  insects,  2$4. 

Stockings  for  infants,  50. 

Stomach  of  the  child  must  rest,  42. 

“ teeth,  when  they  come,  81. 
Stramonium,  poisoning  by,  233. 

Sweet  potatoes,  240. 

Substitutes  for  milk  objectionable,  71. 
Substitute  for  the  breast  for  a few 
days,  38. 

“ for  the  night  gown,  126. 
Succession  of  teeth,  81. 

Sugar,  121. 

“ proportion  in  artificial  feeding,  70. 
Summary  of  the  mother’s  care  of  her- 
self, 21. 

Summer,  dangers  of  the  second,  100. 

“ when  the  first  is  most  criti- 
cal, 101. 

Swallowing  pins,  buttons,  &c.,  218. 
Symptoms  of  choking,  214. 

“ of  convulsions,  202. 
Syringes,  190. 

Table  showing  the  succession  of 
teeth,  81. 

Taking  up  a newborn  child,  33. 

Tapioca  jelly,  242. 

Tea  and  coffee,  109 
Tears  shed  in  sickness,  145. 


Teething,  effect  of,  on  a healthy  nursing 
child,  82. 

remarkable  instance  of  ear- 
ly, 79. 

synopsis  of  what  has  been 
said,  89. 

Teeth  injured  by  candy,  123. 

not  appearing  no  evidence  of  ill 
health,  80. 

order  of  their  coming,  80. 
sometimes  cause  severe  pain  of 
the  gums,  83. 

that  come  during  the  seventh 
month,  80. 

that  come  by  the  tenth  month,  80. 
that  come  by  the  twentieth 
month,  80. 

that  come  during  the  second 
year,  98. 

that  come  after  the  second 
year,  118. 

time  of  first  appearance,  79. 
to  be  kept  clean,  119. 
when  the  grinders  come,  80. 
when  the  stomach  and  eye  teeth 
come,  80. 

The  bed  of  the  child,  46. 
belly-band,  36. 
first  dressing,  34. 
first  nursing,  37. 
first  washing  of  the  child,  32. 
Thirst,  how  quenched  in  diarrhoea,  160 
Throat,  scalding  by  steam,  224. 

Toast  water,  241. 

Toilet  of  children,  124. 

Tooth  powders  for  children,  120. 
Treatment  after  poisoning,  230. 

of  broken  bones,  228. 
of  bruises,  228. 
of  constipation,  151. 

“ “ in  the  moth 

er,  16. 

of  coughs,  165. 
of  choking,  214. 
of  convulsions,  203. 


250 


INDEX 


Treatment  of  diarrhoea,  155. 

“ “ “ in  the  mother,  18. 

“ of  earache,  229. 

“ of  repelled  eruptions,  235. 

“ of  slight  colds,  164. 

“ of  spasmodic  croup,  171. 

“ of  sprains,  227. 

“ of  stings  of  insects,  234. 

“ of  vomiting,  148. 

“ of  wounds,  226. 

“ when  the  head  is  hot,  137. 

Tube  of  nursing  bottle,  material  for,  75. 

Tying  the  cord,  26. 

Tyranny  of  children,  if  allowed,  94. 

Undigested  food  in  the  discharges,  153. 

Use  of  injections,  187. 

Varieties  of  diarrhoea,  152. 

Variety  of  diet  for  children,  108. 

Ventilation,  113. 

“ of  the  sick  room,  180 

Vomiting,  147. 

“ bile,  148. 

“ how  to  check  it,  149. 

‘ in  convulsions,  207. 


Wagons  sometimes  injurious  to  in 
fants,  92. 

Walking,  117. 

Warm  baths  in  convulsions,  204. 
Washing  the  child  the  first  time,  32. 
Water,  drinking  hot,  224. 

“ injurious  in  diarrhoea,  159. 

“ on  the  brain,  143. 

Watery  discharges  from  the  bowels,  152. 
Weaned  children,  their  , diet,  107. 
Weaning,  rules  concerning  it,  101. 

“ the  time  for  it,  99. 

“ when  partial,  92,  103. 

Wet  nurse,  how  to  select  one,  59. 

“ nurses,  objections  to  them,  58. 

“ “ their  tyranny,  58. 

“ “ when  necessary,  56. 

Whooping  cough,  168. 

Windpipe,  seeds,  coins,  &c.,  in  the,  217 
Wine  whey,  236. 

Wheat  gruel,  241. 

Woman’s  milk,  67. 

Wounds,  their  treatment,  226. 


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calf,  gilt  or  antique,  $8.00. 

FENELON. 

ADVENTURES  OF  TELEMACHUS.  By  Fenelon  ; trans- 
lated by  1)r.  Hawkesworth,  with  a Life  of  Fenelon  by  La- 
martine ; Biographical  Notices,  &c.  &c.  Edited  by  O.  W. 
Wight,  A.  M.  In  one  volume,  crown  8vo.  Price  in  extra 
cloth,  uncut,  $2.25 ; half  calf,  gilt  or  antique,  $4.00. 

MONTAIGNE. 

WORKS  OF  MICHAEL  DE  MONTAIGNE.  Comprising 
his  Essays,  Journey  into  Italy,  and  Letters  ; with  Notes  from 
all  the  Commentators,  Biographical  and  Bibliographical  No- 
tices, &c.  By  W.  Hazlitt.  With  a portrait  of  Montaigne. 
A new  and  carefully  revised  edition,  edited  by  O.  W.  Wight. 
In  four  volumes,  crown  8vo.  Price  in  extra  cloth,  uncut, 
$9.00;  half  calf,  gilt  or  antique,  $16.00. 


PUBLICATIONS  OF  HURD  AND  HOUGHTON. 
Z^RIED  LJFE  AT  HILLSIDE.  By  Barry  Gray 

$Ioo  ratl0nS  by  McNevin-  1 TOl-  crown  8 vo.  Priced 

„Am,  fr0m  the  Hudson  County  Republican. 

entirely  Ihefe'i  w °f  “ amnsinS  characler'  « « not  so 

gZtetv’’  deiaWe  Path°S  “ itS  Pa^es>  as  weU  as  .onto 

u . From  the  Boston  Times. 

Ihey  are  lively,  humorous,  and  sparkling.” 

u Frotn  the  N.  Y.  Citizen. 

fh  'pC.  It  S a wo*  Sara‘o?»>  or  any  other  watering-place.  . .. 

.•ts  :zz:ztzzzzmty  in  the  siMy  * iet  - *»»  «* 

MATEIMOMAL  INFELICITIES ; with  an  Occasional 

e ici  y y way  of  Contrast.  By  Barry  Gray.  1 vol 

crown  8m  Price,  $2.00.  7 

t From  the  Hartford  Evening  Press. 

out  !faIG;ay  l00kS  “POn  life  0n  the  funn^  side>  and  extracts  a laugh 
out  of  any  disagreeable  situation.  His  humor  is  sometimes  a little 

IkTh,’  t^  T 1fngUage  is  alwajS  decorous>  and  the  fan  of  his  sketches 
n the  situations,  and  the  admirable  drawing  of  some  of  his  domes 
tic  personages,  and  not  in  extravagant  language.” 

Ww!fhSti;V0™  n^DITIES,  in  Prose.  By  Thomas  Hood. 
With  two  Steel  Engravings,  and  118  Wood-cuts  from  the 
Author  sown  Designs.  1 vol.  crown  8vo.  Price,  *2.00. 

f.  From  the  Literary  Gazette. 

In  the  whole  range  of  his  Works  there  is  not  a single  line  of  in, 
moral  tendency,  or  calculated  to  pain  an  individual.” 

UP  THE  RHINE.  By  Thomas  Hood.  With  two  Steel 
ngravmgs,  and  all  the  original  Designs  of  the  Author 
1 vol.  crown  8vo.  Price,  $2.00. 

u From  the  London  Athenaeum. 

The  master-spirit  of  modern  whim  and  drollery.” 

TALES  AND  EXTRAVAGANZAS.  By  Thomas  Hood 
1 vol.  crown  8vo.  Price,  $2.25. 

From  the  N.  Y.  Christian  Advocate. 

“A  collection  of  some  stories  of  this  funniest  of  the  famous  wits.” 


V I 


